Substance use disorder and personality disorder

Personality traits as predictors of recovery among patients with substance use disorder

INTRODUCTION

Substance use disorder (SUD) is often considered a chronic illness in which prolonged recovery, in terms of abstinence, is uncommon. Personality has been found to predict recovery, but not much is known about its long-term predictive ability as the majority of previous studies have had short follow-up periods (≥ one year). The current longitudinal cohort study therefore investigated whether personality traits predict short- (STR) as well as long-term recovery (LTR) in SUD patients.

METHODS

Treatment-seeking patients with SUD (n = 123) completed the NEO Personality Inventory - Revised. STR and LTR categories were defined as scoring <8 on the Alcohol Use Disorders Identification Test - C and <2 on the Drug Use Disorder Identification Test - C at the one-year and 6-8-year follow-up, respectively. Whether personality traits predicted outcome was investigated by two-tailed independent samples t-tests, α < 0.05. Additional analysis was conducted with latent growth curve model.

RESULTS

Neuroticism (inversely, p = .004, d = 0.55) and Extraversion (p = .04, d = 0.38) predicted STR (n = 114). Although not significant the effect size for Conscientiousness was above the cut-off for a practical significant effect (d = 0.31). No traits predicted LTR category. Still, the effect sizes for LTR regarding Neuroticism (d = 0.36), Extraversion (d = 0.21) and Conscientiousness (d = 0.27) indicated that these traits have relevance for LTR. The latent growth curve model indicated that these traits predicted the short-term use of drugs and long-term use of alcohol in this cohort dominated by patients suffering from severe poly-SUD.

CONCLUSION

Personality traits predict recovery. The effect sizes indicate that more studies with larger samples on personality traits and LTR are required to understand their possible influences on the recovery process.

An Interpretative Phenomenological Analysis on the Experience of Probation Officers in Managing People With Antisocial Personality Disorder

People who are managed by the National Probation Service and convicted of high risk offences will often meet criteria for antisocial personality disorder and have complex psychosocial needs; this group of people present with high risk behavior which may professionals have been reluctant to work with in the past who are associated with higher rates of recidivism. This study investigated the experiences of probation officers in managing people who meet the criteria for Anti Social Personality Disorder. Semi structured interviews were conducted with six participants to capture their experiences of working with this population, the challenges they faced, and coping mechanisms employed, through analysis using Interpretative Phenomenological Analysis (IPA). Three superordinate themes were identified which revealed participants internal feeling, strategies employed, and external challenges. They spoke about internal negative feelings, specifically feeling controlled, having mistrust, a lack of confidence, being overwhelmed with emotion, and experiencing a fear of risk behaviors. Other themes involved external pressures as well as different coping responses. Implications are discussed to help probation officers to understand this population, for the organization to support staff to work with challenging behaviors and prevent burn out, to enable positive outcomes, and for potentially reducing reoffending.

The Tendency to Use Substances/Drugs and its Association with Interpersonal Dependence in Iranian Medical Students

Background

Personality traits or disorders are now attracting more attention as factors in the initiation and continuation of substance/drug use. However, few studies have been conducted on the association between interpersonal dependence and substance/drug use. The present study aimed to investigate the association between this form of psychological dependence and the tendency to use substances/drugs in medical students.

Methods

The present study was based on an analytical cross-sectional design and conducted on 310 medical students selected by stratified sampling at Guilan University of Medical Sciences in 2021. The Interpersonal Dependency Inventory and the Iranian Addiction Potential Scale were employed to assess the two variables of interpersonal dependence and the tendency to use substances/drugs.

Findings

The correlation matrix shows that the tendency to use substances/drugs has a significant negative correlation with interpersonal dependence (P=0.0001, r=-0.285) in general and emotional reliance on another person (P=-0.0001, r=-0.264) and lack of social self-confidence (LSSC) (P=0.0001, r=-0.297) in particular. Female (F=8.57, P=0.004) and married (F=5.14, P=0.024) students showed more tendency to use substances/drugs than male and single students, but no significant difference was observed regarding interpersonal dependence. Academic course, residence status, parents' occupation, number of family members, and birth order did not significantly affect the scores.

Conclusion

Interpersonal dependence can have different functions, depending on its level. Although interpersonal dependence at maladaptive levels can act as a risk factor and make a person vulnerable to some behavioral problems, at adaptive levels, it acts as a protective factor and reduces those problems.

Masculine depression and its problem behaviors: use alcohol and drugs, work hard, and avoid psychiatry!

The gender role influences vulnerability to mental illness. Substance use, even critical in scale, is perceived as masculine, just like hard (over-)work, while not seeking help. With the ongoing separation between gender and sex, masculine norms become more relevant also to females' mental health. The male depression concept highlights the role of male symptoms in affective disorders. However, the empirical evidence is still limited. Here, we use the denomination 'masculine depression' to open the category for female patients and tested substance use patterns, health services' utilization, and working hours as predictors in a case-control study of 163 depressed in-patients (44% women; masculine vs. non-masculine depression according to a median split of the Male Depression Rating Scale-22) and 176 controls (51% women). We assessed higher depression severity in patients with masculine (vs. non-masculine) depression. Masculine depression (vs. non-masculine depression and vs. no depression) was predicted by more frequent and critical use of alcohol (including binge drinking), tobacco, and illicit drugs, and by longer working times. Moreover, fewer health services contacts due to mental complaints during the previous year were associated with masculine (vs. non-masculine) depression. Alarmingly, even critical substance misuse was not significantly associated with more frequent health services contacts; however, the higher the depression severity, the more contacts the patients reported. Here, we provide evidence that patients with masculine depression are highly burdened and undertreated, which applies equally to female and male patients. This study identified promising targets to establish specialized care offers.

Evidence-Based Assessment of Substance Use Disorder

The current review describes updated information on the evidence-based assessment of substance use disorder. We offer an overview of the state of the science for substance-related assessment targets, instruments (screening, diagnosis, outcome and treatment monitoring, and psychosocial functioning and wellbeing) and processes (relational and technical) as well as recommendations for each of these three components. We encourage assessors to reflect on their own biases, beliefs, and values, including how those relate to people that use substances, and to view the individual as a whole person. It is important to consider a person's profile of symptoms and functioning inclusive of strengths, comorbidities, and social and cultural determinants. Collaborating with the patient to select the assessment target that best fits their goals and integration of assessment information in a holistic manner is critical. We conclude by providing recommendations for assessment targets, instruments, and processes as well as recommendations for comprehensive substance use disorder assessment, and describe future directions for research.

The Co-occurrence of Personality Disorders and Substance Use Disorders

PURPOSE OF REVIEW

Despite significant negative outcomes, the co-occurrence of personality disorders (PDs) and substance use disorders (SUDs) continues to be underrecognized, and the mechanisms contributing to this co-occurrence remain unclear. This review summarizes recent work on PD-SUD co-occurrence, with a focus on borderline and antisocial PDs, general substance use patterns among those with PDs, and the association of personality traits with SUDs.

RECENT FINDINGS

The prevalence of co-occurring PD-SUD is generally high, with estimates ranging depending on the type of PD and SUD, the population assessed, and the sampling methods and measures used. Current theoretical explanations for co-occurrence include shared etiology and predisposition models, with research highlighting the importance of transactional processes. Potential underlying mechanisms include personality traits and transdiagnostic characteristics. Recent research has increased focus on substances besides alcohol, dimensional models of personality pathology, and transactional explanations of co-occurrence, but more research is needed to disentangle the nuanced PD-SUD relationship.

Correlates of Homelessness Among Adults with Personality Disorder

Although personality disorders (PDs) are more common among persons experiencing homelessness than the general population, few studies have investigated the risk of experiencing homelessness among persons with PDs. This study seeks to identify the demographic, socioeconomic, and behavioral health correlates of past-year homelessness among persons with antisocial, borderline, and schizotypal PDs. Nationally representative data of the civilian, noninstitutionalized population of the United States was used to identify correlates of homelessness. Descriptive statistics and bivariate associations between variables and homeless status were summarized prior to conducting several multivariate logistic regression models to identify correlates of homelessness. Main findings revealed positive associations between poverty, relationship dysfunction, and lifetime suicide attempt with homelessness. In the antisocial PD (ASPD) and borderline PD (BPD) models, comorbid BPD and ASPD, respectively, were associated with higher odds of past-year homelessness. Findings underscore the importance of poverty, interpersonal difficulties, and behavioral health comorbidities on homelessness among persons with ASPD, BPD, and schizotypal PD. Strategies to promote economic security, stable relationships, and interpersonal functioning may buffer against the effects of economic volatility and other systemic factors that could contribute to homelessness and persons with PD.

C-L Case Conference: Applying Good Psychiatric Management for Borderline Personality Disorder in Hospitalized Patients With Co-occurring Substance Use Disorders

We present a case illustrating common challenges in the hospital management and treatment of comorbid borderline personality disorder and substance use disorders. Experts in the field of personality disorders and substance use disorders discuss various topics and strategies for patient-centered management. Key learning points include evaluation and diagnosis of borderline personality disorder, good psychiatric management, withdrawal and pharmacologic management, harm reduction, team dynamics, and behavior planning all in the hospital setting. This paper provides actionable considerations with elements common to many clinical encounters that present challenges to the consultation-liaison psychiatrist in the general hospital setting.

Patient and health-care provider experience of a person-centred, multidisciplinary, psychosocial support and harm reduction programme for patients with harmful use of alcohol and drug-resistant tuberculosis in Minsk, Belarus

Background

Tuberculosis (TB) often concentrates in groups of people with complex health and social issues, including alcohol use disorders (AUD). Risk of TB, and poor TB treatment outcomes, are substantially elevated in people who have AUD. Médecins sans Frontières and the Belarus Ministry of Health have worked to improve treatment adherence in patients with multi-drug or rifampicin resistant (MDR/RR)-TB and harmful use of alcohol. In 2016, a person-centred, multidisciplinary, psychosocial support and harm reduction programme delivered by TB doctors, counsellors, psychiatrists, health-educators, and social workers was initiated. In 2020, we described patient and provider experiences within the programme as part of a wider evaluation.

Methods

We recruited 12 patients and 20 health-care workers, using purposive sampling, for in-depth individual interviews and focus group discussions. We used a participant-led, flexible, exploratory approach, enabling participants and the interviewer to shape topics of conversation. Qualitative data were coded manually and analysed thematically. As part of the analysis process, identified themes were shared with health-care worker participants to enable their reflections to be incorporated into the findings.

Results

Key themes related to the patients’ and practitioners experience of having and treating MDRTB with associated complex health and social issues were: fragility and despair and guidance, trust and health. Prejudice and marginalisation were global to both themes. Counsellors and other health workers built a trusting relationship with patients, enabling guidance through a multi-disciplinary approach, which supported patients to achieve their vision of health. This guidance was achieved by a team of social workers, counsellors, doctors and health-educators who provided professional and individualised help for patients’ illnesses, personal or interpersonal problems, administrative tasks, and job searches.

Conclusions

Patients with MDR/RR-TB and harmful use of alcohol faced complex issues during treatment. Our findings describe how person-centred, multi-disciplinary, psychosocial support helped patients in this setting to cope with these challenges and complete the treatment programme. We recommend that these findings are used to: i) inform programmatic changes to further boost the person-centred care nature of this program; and ii) advocate for this type of person-centred care approach to be rolled out across Belarus, and in contexts that face similar challenges.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08525-x.

Cluster B personality disorders and its associated factors among psychiatric outpatients in Southwest Ethiopia: institutional-based cross-sectional study

BACKGROUND

Diagnosis of co-occurring personality disorders, particularly the most comorbid cluster B personality disorders in psychiatric patients is clinically important because of their association with the duration, recurrence, and outcome of the comorbid disorders. The study aimed to assess the prevalence of cluster B personality disorders and associated factors among psychiatric outpatients in Jimma Medical Center.

METHODS

An institution-based cross-sectional study was conducted among 404 patients with mental illnesses at Jimma Medical Center from July 15 to September 14, 2021. A systematic random sampling method was used to recruit the participants. Personality disorder questionnaire four (PDQ-4) was used to assess the prevalence of cluster B personality disorders through a face-to-face interview. Data were entered into Epi Data Version 4.6 and exported to SPSS Version 26 for analysis. Logistic regression analysis was done and variables with a p-value less than 0.05 with a 95% confidence interval in the final fitting model were declared as independent predictors of cluster B personality disorders.

RESULT

Amongst 401 respondents with response rate of 99.3%, slightly less than one-fourth (23.19%, N = 93) were found to have cluster B personality disorders. Unable to read and write(AOR = 3.28, 95%CI = 1.43-7.51), unemployment(AOR = 2.32, 95%CI = 1.19-4.49), diagnosis of depressive (AOR = 3.72, 95%CI = 1.52-9.10) and bipolar-I disorders (AOR = 2.94, 95%CI = 1.37-6.29), longer duration of illness (AOR = 2.44, 95%CI = 1.33-4.47), multiple relapses (AOR = 2.21, 95%CI = 1.18-4.15)), history of family mental illnesses (AOR = 2.05, 95%CI = 1.17-3.62), recent cannabis use (AOR = 4.38, 95%CI = 1.61-11.95), recent use of alcohol (AOR = 2.86, 95%CI = 1.34-6.10), starting to use substance at earlier age (AOR = 4.42, 95%CI = 1.51 -12.96), and suicidal attempt (AOR = 2.24, 95%CI = 1.01-4.96), were the factors significantly associated with cluster B personality disorders.

CONCLUSION

The prevalence of cluster B personality disorders was high among mentally ill outpatients and found to be important for mental health professionals working in the outpatient departments to screen for cluster B personality disorders as part of their routine activities, particularly those who have mood disorders, longer duration of illness, multiple relapses, history of family mental illnesses, suicidal attempt and are a current user of alcohol and cannabis.

Emotion Dysregulation and Affective Temperaments in Opioid Use Disorder: the preliminary results of a prospective study

BACKGROUND

Substance use disorder is a growing health problem all over the world. The coexistence of substance misuse, affective temperaments, and emotion dysregulation has not been studied sufficiently.

OBJECTIVE

The present study aimed to evaluate the role of affective temperaments and emotion dysregulation on substance use disorder. The Emotion Dysregulation and Affective Temperaments in Opioid Use Disorder study was designed observational. This paper presents only the baseline assessments of the patient and control groups. One-year remission rates of the patients' group will be reported elsewhere after 1-year follow-up.

METHODS

Sixty-seven patients with opioid use disorder and 68 healthy controls enrolled. All participants were administered to The Structured Clinical Interview for DSM-5, Temperament Evaluation of Memphis, Pisa, Paris, San Diego Autoquestionnaire, Difficulties in Emotion Regulation Scale, Beck Anxiety Inventory, and Beck Depression Inventory.

RESULTS

Patients with opioid use disorder had higher scores from all temperamental scales and showed higher difficulties on emotion regulation than the control group. Even controlling the confounding effects of anxiety and depression levels, dysthymic and anxious temperament scores were found correlated with the emotion dysregulation score in the patient group.

CONCLUSIONS

The emotional traits (i.e., affective temperaments) and emotion regulation abilities play a crucial role in substance use disorder. While managing substance use disorder, being aware of affective temperament characteristics and/or interventions to improve emotion regulation skills may be helpful.

Intensive Dialectical Behavior Treatment for Individuals With Borderline Personality Disorder With and Without Substance Use Disorders

Treatment of borderline personality disorder (BPD) with comorbid substance use disorder can be challenging due to symptom overlap and limited assessment methods. Preliminary evidence has shown promising effectiveness of dialectical behavioral therapy (DBT) for BPD with comorbid substance use disorders. The current study compared the benefits of a 28-day transitional DBT treatment program for individuals with BPD with and without substance use disorders through evaluating the changes in coping skills, generalized anxiety, and depression symptom scales at admission and discharge. A total of 76 patients were split into two groups: Group 1 consisted of individuals with BPD without substance use disorders (n = 41), and Group 2 involved individuals with BPD and a substance use disorder (SUD) (n = 35). A univariate general linear model showed significant differences between the two groups in improvement of coping skills and depressive symptoms. After a 28-day transitional DBT treatment program there were significant decreases from severe to moderate depression scores in both groups. Our findings support the effectiveness of DBT treatment in patients with comorbid BPD and SUD.

Personality Disorders, Risky Behaviors, and Adversity: The Moderating Role of Resilience

Individuals with personality disorders (PDs) comprise 30% to 40% of individuals receiving mental health treatment. Treatment of PDs is exceedingly difficult; therefore, research has focused on PD etiology and preventative factors. One known influence on PD etiology is adverse childhood experiences (ACEs). ACEs are associated with increased prevalence of several health risk behaviors (HRBs), including engagement in substance use, criminal, and risky sexual behavior. One protective factor, childhood resiliency, predicts lower prevalence of PDs and engagement in HRBs. We hypothesized that increased prevalence of ACEs would predict higher levels of PD symptoms and HRBs engagement. Furthermore, we predicted that childhood resiliency would moderate the relation between ACEs, PD symptoms, and HRBs. In the present study, students (N = 531) completed the Adverse Childhood Experiences survey, the Self-Administered - Standardized Assessment of Personality Abbreviated Scale, and the Childhood Youth and Resiliency Measure-28. They also responded to questions about substance use, criminal, and sexual behavior which were used to define a latent HRB variable. Structural equation modeling was conducted to examine study hypotheses. As hypothesized, we found positive relations between ACEs, PD symptoms, and our HRB latent variable. Childhood resiliency moderated both ACE and PD symptom paths. At lower levels of reported ACEs, individuals high in childhood resiliency reported fewer PD symptoms and HRBs than individuals low in childhood resiliency. At high levels of ACEs, childhood resiliency did not serve as a protective factor. Additionally, study findings suggest that childhood resiliency factors are integral for protecting against the development of these disorders.

Understanding the Relationship Between Complicated Grief Symptoms and Patterns of Personality Disorders in a Substance Users' Sample: A Network Analysis Approach

BACKGROUND

The presence of personality disorders is greatly prevalent among substance users. Personality disorders could increase vulnerability to complicated grief symptoms. Bereavement is commonly overlooked among substance users. We used network analysis to estimate the structure of relations between patterns of personality disorders and complicated grief symptoms among a bereaved substance-using population.

METHODS

Complicated grief and personality disorders were assessed in a sample of 196 bereaved substance users. We use the graphical least absolute shrinkage selection operator (LASSO) to compute a regularized partial correlation network revealing associations among different patterns of personality disorders and complicated grief symptoms.

RESULTS

In a network involving nodes for personality disorders and symptomatology of complicated grief, patterns of depressive and paranoid personality disorder showed small relationships to complicated grief symptoms. All other personality disorders showed negligible to no relationship to complicated grief symptoms. Further, in the overall network, complicated grief showed the lowest level of centrality, suggesting that it is independent of personality disorders, whereas depressive and paranoid personality disorder symptoms showed the highest centrality.

CONCLUSION

Network analysis can be used to understand the relationships among higher-level constructs such as disorders. We found that complicated grief is largely independent of patterns of personality disorders with the exception of depressive and paranoid. Findings have implications for assessment and appropriate treatment of complicated grief symptoms and substance use disorder.

Exploring substance use disorders and relapse in Mauritian male addicts

Background

Substance Use Disorder (SUD) places a heavy burden on societal and health systems given its association with high mortality and morbidity rates worldwide, including Mauritius. Illicit substances act as a positive reinforcement and stimulate addiction through its pleasure-seeking attributes.

Aim

This study focused on identifying the risk factors leading to SUD among Mauritian male addicts as well as examining the potency of those factors in SUD development. The study also aimed at determining the prevalence of relapse and its causation.

Research setting

A cross-sectional study was conducted over a period of six months using a sample of 180 male addicts registered in a public hospital. A questionnaire investigating dimensions such as risk factors, self-esteem and peer pressure was administered.

Findings

A high percentage of relapse was noted amongst users within the first year of abstinence. Majority of respondents originated from nuclear or single parents’ family and were deprived of adequate social supports given their marital status. 57.5% of participants had a positive family history of SUD. Cannabis was the most commonly abused substance and 76.2% of the addicts were introduced to drugs through curiosity. Transposing the results against the Gateway Drug Theory showed a constant progression from soft to hard drugs for male addicts, a trend which was consistent with literature. Lastly, a theoretical model was developed based on the strong statistical association found between impulsivity and reduced thought processes prior to relapse; data revealing increased impulsivity which is a common trait in antisocial personality disorder and borderline personality disorder as being largely responsible for relapse.

Conclusion

The study was successful in bringing out the most common risk factors of SUDs which are linked to low socioeconomic status. The inability of addicts to progress with their rehabilitation given the alarming 92% of relapse was related to social pressure as prime deterrent to successful remission. Programmes involving relapse prevention must implemented in the first year of abstinence to facilitate rehabilitation.

Substance use disorders and risk for treatment resistant depression: a population-based, nested case-control study

BACKGROUND AND AIMS

Treatment-resistant depression (TRD), defined as inadequate treatment response after at least two adequate treatment trials, is common among patients initiating antidepressant treatment. Current or previous substance use disorders (SUD) are common among patients with depression and often lead to worse treatment outcomes. However, in clinical studies, SUD have not been found to increase the risk for TRD. The aim of this study was to investigate the association between SUD and TRD.

DESIGN

Nested case-control study.

SETTING

Nation-wide governmental health-care registers in Sweden.

CASES AND CONTROLS

Data on prescribed drugs and diagnoses from specialized health care were used to establish a prospectively followed cohort of antidepressant initiators with depression (n = 121 669) from 2006 to 2014. Of these, 15 631 patients (13%) were defined as TRD cases, with at least three treatment trials within a single depressive episode. Each case with TRD was matched on socio-demographic data with five controls with depression.

MEASUREMENTS

Crude and adjusted odds ratios (aOR) with 95% confidence intervals (CI) estimated the association between TRD and SUD diagnosis and/or treatment in five different time intervals until the time for fulfillment of TRD definition for the case. The analysis was adjusted for clinical and socio-demographic covariates.

FINDINGS

Having any SUD during, or ≤ 180 days before start of, antidepressant treatment was associated with almost double the risk for TRD [≤ 180 days before: adjusted OR (aOR) = 1.86, CI = 1.70-2.05]. Increased risks for TRD were found ≤ 180 days before treatment start for the subcategories of sedative use (aOR = 2.37; 1.88-2.99), opioids (aOR = 2.02; 1.48-2.75), alcohol (aOR = 1.77; CI = 1.59-1.98) and combined substance use (aOR = 2.31; 1.87-2.99).

CONCLUSIONS

Recent or current substance use disorders is positively associated with treatment resistance among patients initiating treatment for depression.

The Psychometric Properties of a Short UPPS-P Impulsive Behavior Scale Among Psychiatric Patients Evaluated in an Emergency Setting

Objective: Impulsivity is a multidimensional construct that has an important role for the understanding of diverse psychopathologies and problematic behaviors. The UPPS-P impulsive behavior scale, measuring five distinct facets of impulsivity, has been subject to several studies. No study has investigated the clinical utility of this questionnaire amongst an unstable psychiatric population. The aim of the current study is to examine the psychometric properties of the short version of this scale in a psychiatric emergency unit. Method: The S-UPPS-P was administered to 1,097 psychiatric patients in an emergency setting, where a subgroup of 148 participants completed a follow-up. The internal consistency, the construct validity, the test-retest reliability, and correlations with a substance misuse measure were examined. Results: Confirmatory factor analyses supported a five-factor solution. Results indicated good psychometric properties across psychiatric diagnoses and gender. The S-UPPS-P was partially invariant across sexes. The authors have found differences on the loading of one item and on the thresholds of two items from lack of premeditation and positive urgency subscales. Conclusion: This validation study showed that the UPPS-P conserved good psychometric properties in an unstable psychiatric sample, indicating that the instrument can be utilized in such settings.

Co-Morbidity of DSM-IV Personality Disorder in Major Depressive Disorder Among Psychiatric Outpatients in China: A Further Analysis of an Epidemiologic Survey in a Clinical Population

Introduction: It is common that personality disorder (PD) co-occurs with major depressive disorder (MDD). In the current literature, there is a dearth of information on the co-occurrence of PD and MDD among Chinese population. Materials and Methods: 609 individuals were randomly sampled from outpatients diagnosed as MDD in Shanghai Mental Health Center. Co-morbidity of PDs was assessed using the Personality Diagnostic Questionnaire Fourth Edition Plus (PDQ-4+) and eligible subjects were interviewed with the Structured Clinical Interview for DSM-IV Axis II (SCID-II). The score of PDQ-4+ and the rate of SCID-II PD between subjects diagnosed with MDD and those with anxiety disorders (AD) were compared. Results: Two hundred fifty-eight outpatients (42.36%) with MDD were recognized to possess at least one criterion of diagnosis for PD, according to the DSM-IV. The most prevalent PD was depressive PD (14.61%), followed by avoidant (11.49%) and borderline (11.49%) PD. Cluster C PDs (anxious and panic PD) were the most common PD types (12.12%) when compared to other clusters. Compared to patients with AD, individuals with MDD were significantly more likely to have paranoid PD (6.6% vs. 3.3%, p = 0.011), borderline PD (11.5% vs. 3.7%, p = 0.000), passive-aggressive PD (5.6% vs. 2.4%, p = 0.007), and depressive PD (14.6% vs. 7.8%, p = 0.000). Discussion: The finding indicates that there is a high prevalence of PD among patients with MDD. More significant co-morbidity rates of PDs in MDD have been found when compared with AD. Further studies for the longitudinal impact of the PD-MDD co-morbidity are in need.

Borderline personality disorder features and drinking, cannabis, and prescription opioid motives: Differential associations across substance and sex

INTRODUCTION

Drinking motives have shown meaningful associations with borderline personality disorder (BPD) features. However, it is unknown whether other common substances of abuse (namely cannabis and prescription opioids) have the same associations with BPD features. In the present study, we tested associations between BPD features and motives across three substances: alcohol, cannabis, and prescription opioids. The purpose of the study was to determine whether BPD showed similar patterns of associations across drugs, or whether some substances serve particular functions for individuals with BPD features, and whether this also varies by sex in a college student sample.

METHOD

Five-hundred ninety-four college students completed online questionnaires measuring demographics, borderline personality disorder features, substance use, and substance specific motives for alcohol, cannabis, and prescription opioid use.

RESULTS

BPD was most strongly associated with coping motives across all substances. For both alcohol and cannabis, this was true for both males and females, along with conformity motives. For prescription opioids, coping, social, enhancement, and pain motives were only significantly related to BPD features for females. When compared statistically, it was found that the associations with coping drinking motives and opioid pain motives were higher among females.

CONCLUSIONS

This pattern of results suggests that negatively reinforcing motives (coping and conformity) play a similar functional role in borderline personality and substance use disorder pathology for alcohol and cannabis, but for prescription opioids the negative reinforcement motives (coping and pain) were only evident in females.

Comorbidity of Personality Disorder among Substance Use Disorder Patients: A Narrative Review

Comorbidity of personality disorders (PDs) and substance use disorders (SUDs) is common in clinical practice. Borderline PD and antisocial PD are particularly found to be associated with SUDs. Our review suggests that the overall prevalence of PD ranges from 10% to 14.8% in the normal population and from 34.8% to 73.0% in patients treated for addictions. Even though the types of PD seen in patients with drug and alcohol use disorder are similar, the prevalence of any PD is higher among patients with drug use disorder than alcohol use disorder. The higher comorbidity between these two conditions has been explained by a primary personality pathology followed by a secondary development of a SUD. The comorbidity with PD positively correlates with the severity of the SUD. Comorbid PD among patients with SUDs is a predictor of poor prognosis in terms of poorer treatment response and outcome. Psychotherapy is the mainstay of treatment in comorbid condition with dialectical behavioral therapy, dynamic deconstructive psychotherapy, and dual-focused schema therapy having the most evidence base. Pharmacotherapy is primarily indicated for the acute crisis management or for the treatment of other comorbid conditions such as psychosis and depression. However, the evidence is insufficient as of now to suggest one treatment over the other. Further research is required to identify more efficacious treatment approaches for this comorbidity.

Multi-Trait Profiles and their Relation to Substance Use Problems and Cluster B Personality Disorder Features: A Replication Study

Substance use disorders (SUDs) and Cluster B personality disorders (PDs) may have shared risk through profiles of personality and motivational traits. The present study sought to replicate in a national sample of adults past research which found multi-trait profiles that were associated with disinhibitory disorders in a college sample. Another aim was to test whether gender differences in the prevalence of disinhibitory disorders are attributable to underlying differences in personality-based risk. Cluster analysis was used to identify multi-trait profiles from impulsivity, constraint, negative emotionality, behavioral activation system (BAS), and behavioral inhibition system (BIS) scale scores. Analyses yielded similar multi-trait profiles to those found in past research, including a “disinhibited” profile with high impulsivity, high BAS, and low constraint, as well as a “high affectivity/impulsive” profile with high negative emotionality, impulsivity, BAS, and BIS. These profiles were associated with elevated drug problems and Cluster B PD features. Results support the validity these trait profiles and their association with disinhibitory psychopathology. Gender was associated with some, but not all, disinhibitory disorders while controlling for cluster membership, suggesting that multi-trait personality clusters may represent a more proximal risk factor than gender for certain disinhibitory disorders.

Prevalence Rates of Personality Disorder and Its Association With Methamphetamine Dependence in Compulsory Treatment Facilities in China

Methamphetamine use is popular and rapidly increasing in China, and the co-occurrence of personality disorders has an impact on treatment outcomes and may increase vulnerability of developing dependence. The aim of the present study was to investigate the prevalence rates of personality disorders in methamphetamine users and further explore the association between personality disorders and methamphetamine use status. Five hundred and seventy-seven male methamphetamine users were recruited. The self-developed questionnaire was used for demographics, and a Structural Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (SCID-I/II) was performed covering psychiatric diagnosis. Our study found the prevalence of antisocial personality disorder in male methamphetamine users was 71.4%, followed by borderline (20.2%) and obsessive-compulsive (17.9%) personality disorder. Borderline and antisocial personality disorders were found to be risk factors of methamphetamine dependence (adjusted odds ratio = 2.891, p = 0.007 and adjusted odds ratio = 1.680, p = 0.042). These findings suggested personality disorders were highly prevalent in male methamphetamine users, and the comorbidity of antisocial and borderline personality disorders are especially associated with methamphetamine dependence.

Risk of Suicide and Dysfunctional Patterns of Personality among Bereaved Substance Users

Background: Research has shown that suicide is a phenomenon highly present among the drug dependent population. Different studies have demonstrated an upraised level of comorbidity between personality disorders (PD) and substance use disorders (SUD). This study aimed to describe which PDs are more frequent among those patients with a risk of suicide. Methods: The study was based on a consecutive non-probabilistic convenience sample of 196 bereaved patients attended to in a Public Addiction Center in Girona (Spain). Sociodemographic data, as well as suicide and drug related characteristics were recorded. The risk of suicide was assessed with the Spanish version of “Risk of suicide”. Personality disorders were measured with the Spanish version of Millon Multiaxial Clinical Inventory. Results: The PDs more associated with the presence of risk of suicide were depressive, avoidant, schizotypal and borderline disorders. However, the histrionic, narcissistic and compulsive PDs are inversely associated with risk of suicide even though the narcissistic scale had no statistical correlation. Conclusions: The risk of suicide is a significant factor to take into account related to patients with SUD and especially with the presence of specific PDs. These findings underline the importance of diagnosing and treating rigorously patients with SUD.

Assessment of personality problems among patients with substance use disorders

Aim

Several studies have shown that personality disorders (PDs) are frequently occurring among patients with substance use disorders (SUDs). A development from research of co-occurrence estimates in this patient group investigates personality problems as dimensional constructs, which seek to capture the core of personality pathology. The aim of our study was to explore whether personality problems might be assessed among SUD patients in early stages of treatment. We also sought to investigate personality problem severity among Norwegian adult SUD patients.

Design

Personality problems were assessed using the self-report questionnaire Severity Indices of Personality Problems (SIPP-118). The study sample consisted of 155 SUD patients currently in treatment at detoxification sections at Oslo University Hospital.

Results

Though psychometric evaluation of the SIPP-118, we found that personality problems could be assessed with high levels of internal consistency and convergent validity in SUD patients during detoxification. This is an important contribution to the discussion concerning time and context of personality pathology assessment in the SUD treatment field. The results indicated that SUD patients have personality problems at a level of severity comparable to previously investigated PD patient samples, and significantly more severe than personality problems found in normal population samples. This indicates that personality problems are a common, as well as a detrimental, feature among SUD patients, which further points towards considering these in all aspects of SUD treatment.

Conclusions

Assessing personality problems early in treatment may enable a more integrated approach to SUD treatment targeting personality problems and substance-related problems.

Persönlichkeitsstörungen – unterdiagostiziert bei Patienten des Maßregelvollzugs gemäß § 64 StGB?1

Zusammenfassung. Ziel: Prüfung der Validität von Persönlichkeitsstörungsdiagnosen (PS-Diagnosen) bei Patienten der forensischen Entziehungsanstalten. Methodik: Drei Datenquellen werden herangezogen. (1) Die Entwicklung der Vergabe von Diagnosen und weitere Behandlungsparameter über einen Zeitraum von 20 Jahren werden anhand der jährlichen § 64-Stichtagserhebung beschrieben. (2) Diagnostische Einschätzungen durch Behandler und externe Untersucherinnen werden für eine Stichprobe von 109 alkoholabhängigen Patienten gegenübergestellt. (3) Auf der Basis von Daten einer laufenden Evaluationsstudie (n = 315) wird die Aussagekraft der Klinikdiagnosen mit einer dimensionalen Einschätzung der Patienten verglichen. Ergebnisse: (1) Ein enormer Rückgang der PS-Diagnosen in der Praxis korrespondiert nicht mit anderen Parametern wie dem Anteil negativer Behandlungsverläufe. (2) Die Übereinstimmung von Behandlern und externen Untersucherinnen hinsichtlich PS-Diagnosen ist kaum besser als nach Zufall zu erwarten. (3) Die PS-Diagnosen der Behandler haben praktisch kein prognostisches Gewicht. Dagegen leistet die kurze dimensionale Einschätzung einen signifikanten Beitrag zur Vorhersage des Outcomes (insbesondere: Entlassung in die Freiheit nach günstigem Verlauf vs. „Erledigung“ der Unterbringung mangels Erfolgsaussicht). Schlussfolgerung: Die Aussagekraft der in der Praxis gestellten kategorialen PS-Diagnosen ist gering. Der Rückgang von PS-Diagnosen scheint vor allem Folge einer Stabilisierung des Vollzugs selbst zu sein. Wohlverhalten und Stabilität im Stationsalltag sollten jedoch nicht den primären Maßstab für diagnostische Einschätzungen bilden.

Cluster B Personality Disorder Traits as a Predictor of Therapeutic Alliance Over Time in Residential Treatment for Substance Use Disorders

While poor therapeutic alliance is a robust predictor of poor outcome in substance abuse treatment, less is known about the barriers to therapeutic alliances in this group. To explore this issue, this study examined whether the severity of cluster B personality disorders predicted therapeutic alliances concurrently and prospectively in a residential substance treatment program for homeless veterans. Participants were 48 adults with a substance abuse disorder. Personality disorder traits were assessed using the Structured Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Personality Disorders, whereas therapeutic alliance was assessed at baseline using the Working Alliance Inventory. Partial correlations controlling for overall symptom severity measured with the Symptom Checklist 90 and education, revealed cluster B traits at baseline predicted all 4 assessments of therapeutic alliance even after controlling for initial levels of therapeutic alliance. Results suggest that higher levels of cluster B traits are a barrier to the formation of working alliances in residential substance treatment.

Impulsivity and risk for prescription opioid misuse in a chronic pain patient sample

Misuse of, and addiction to, prescription opioid pain relievers is a growing concern, in both non-clinical samples and chronic pain patients receiving opioid analgesic therapy. Research is needed to identify which patients may be more prone to misuse or dependence on opioids in a chronic pain treatment setting. Based on literature showing the role of impulsivity in substance use disorders generally, we predicted that impulsivity may also be important to understanding which individuals may be at risk for opioid misuse when opioids are prescribed for pain. The present study examined associations between impulsivity facets and measures of prescription opioid misuse and symptoms. Four facets of impulsivity were examined: urgency, sensation seeking, lack of premeditation, and lack of perseverance. 143 patients receiving treatment for chronic pain at a regional pain clinic completed a series of questionnaires including the UPPS and measures of opioid risk and misuse. Consistent with predictions, urgency was associated with risk for future misuse (β=0.246, p<0.05), current misuse (β=0.253, p<0.01), and symptoms of current opioid use disorder (OUD; β=0.206, p<0.05). Sensation seeking was also associated with current misuse (β=0.279, p<0.01). These results suggest that identifying facets of impulsivity is important to understanding and assessing for risk of prescription opioid misuse in the context of chronic pain treatment. These data indicate that patients who react impulsively to negative mood states and cravings may be especially prone to developing aberrant use patterns when taking prescription opioids. This is the first known study to identify the role of urgency in predicting risk for OUDs in chronic pain patients.

Narcissistic Vulnerability and Addiction

The main body of research on addiction and pathological narcissism has focused on the study of their co-occurrence by applying Diagnostic and Statistical Manual of Mental Disorders ( DSM) definitions for these clinical phenomena or by assessing trait narcissism in substance-dependent populations. Clinically informed comprehensive conceptualizations of narcissism which focus on its phenomenological range from vulnerability to grandiosity have not been applied in studying the specific narcissistic disturbances that underlie the relationship between these comorbid conditions. Aiming to examine this relationship, this study compared the presence of pathological narcissism, and more specifically narcissistic grandiosity and vulnerability, in substance-dependent individuals in treatment with individuals from the general population. Comparisons indicate that substance-dependent individuals experience significant narcissistic disturbances more likely related to vulnerability than grandiosity. Shame, rage, and self-esteem contingent upon external validation comprise the intrapsychic and interpersonal vulnerability. Implications for the clinical conceptualization of pathological narcissism as well as for substance dependence treatment interventions are discussed.

Associations between personality disorder characteristics and treatment outcomes in people with co-occurring alcohol misuse and depression

BACKGROUND

Personality disorders are highly comorbid with alcohol misuse and depressive symptomatology; however, few studies have investigated treatment outcomes in this population. The aim of this study was to examine relationships between baseline personality disorder cluster profiles and overall and treatment-related changes for those with co-occurring alcohol misuse and depression.

METHODS

Secondary analysis was conducted using a subset of data (N = 290) from two randomised controlled trials of psychological interventions for co-occurring alcohol misuse and depression, which did not specifically target personality disorders. Baseline dimensional personality disorder cluster scores were derived from the International Personality Disorder Examination Questionnaire (IPDEQ). Four treatment conditions were compared: a brief integrated intervention, followed by no further treatment, or nine further sessions of integrated-, alcohol-, or depression-focused treatment. Associations between IPDEQ scores and changes in alcohol use, depressive symptoms and functioning from baseline to the 6- and the 12-month follow-ups were of primary interest.

RESULTS

Personality disorder cluster scores moderately negatively impacted on overall change (primarily Cluster C), as well as treatment-related outcomes (primarily Cluster A), particularly changes in depressive symptoms and psychosocial functioning. Longer interventions appeared to be more effective in the longer-term (e.g., at 12-month follow-up), with integrated interventions relatively more effective than single-focused ones for individuals with higher personality disorder cluster scores.

CONCLUSIONS

Greater attention needs to be paid to particular personality disorder clusters during the assessment and treatment of individuals with co-occurring alcohol misuse and depression. Integrated interventions, incorporating motivational interviewing and cognitive behaviour therapy, may provide a useful therapeutic framework. Integrated interventions also provide opportunities for adjunctive components focussing on other issues and coping strategies (e.g., to offset negative affective states), potentially tailored to the characteristics and needs of individual participants.

Predicting problematic alcohol use with the DSM-5 alternative model of personality pathology

High comorbidity between personality disorders and alcohol use disorders appears related to individual differences in underlying personality dimensions of behavioral undercontrol and affective dysregulation. However, very little is known about how the Diagnostic and Statistical Manual of Mental Disorders (5th edition; DSM-5) Section III trait model of personality pathology relates to alcohol problems or how the strength of the relationship between personality pathology and alcohol problems changes with age and across gender. The current study examined these questions in a sample of 877 participants using the General Assessment of Personality Disorder to assess general personality dysfunction, the Personality Inventory for DSM-5 to measure specific traits, and the Alcohol Use Disorder Identification Test (AUDIT) to assess problematic alcohol use. Results demonstrated that general personality pathology (Criterion A) was significantly related to problematic alcohol use after controlling for age and gender effects. Furthermore, 2 of the 5 higher-order personality trait domains (Criterion B), Antagonism and Disinhibition, remained significant predictors of problematic alcohol use after accounting for the influence of general personality pathology; however, general personality pathology no longer predicted hazardous alcohol use once Antagonism and Disinhibition were added into the model. Finally, these 2 specific traits interacted with age, such that Antagonism was a stronger predictor of AUDIT scores among older individuals and Disinhibition was a stronger predictor of alcohol problems among younger individuals. Findings support the general validity of this new personality disorder diagnostic system and suggest important age effects in the relationship between traits and problematic alcohol use. (PsycINFO Database Record

Pathways to Vulnerability for Alcohol Problem Severity in a Treatment-Seeking Sample

OBJECTIVES

The present investigation examined the role of gender, family history of alcohol and drug use disorders, temperament, childhood behavior problems, and adult psychopathology, on adult alcohol use disorder (AUD) severity.

METHODS

Structural equation modeling was used to examine multiple etiological pathways to adult alcohol use disorder (AUD) severity. Participants included 335 treatment-seeking males and females with current or lifetime DSM-III-R alcohol dependence (96%) or abuse (4%) enrolled in one of five treatment outcome studies. Extensive assessment at treatment entry used a mixture of retrospective and current self-report.

RESULTS

Results identified two significant paths associated with a latent factor of adult alcohol use disorder severity at entry to treatment. In Path 1, male gender and family history of drug use disorder predicted greater childhood behavior problems, which predicted antisocial personality disorder (ASPD), borderline personality disorder (BPD), and anxiety disorders (ADs), with anxiety disorders leading directly to alcohol use disorder severity. In Path 2, family history of alcohol use disorder predicted difficult temperament in childhood, which predicted borderline personality disorder, major depressive disorder (MDD) and anxiety disorders; both major depressive disorder and anxiety disorders in turn predicted alcohol use disorder severity at treatment entry.

CONCLUSIONS

The present findings build on the literature on heterogeneity in developmental risk processes leading to the expression of adult alcohol use disorder symptomology among patients presenting for alcohol use disorder treatment.

Risk Factors for Borderline Personality Disorder in Treatment Seeking Patients with a Substance Use Disorder: An International Multicenter Study

Borderline personality disorder (BPD) and substance use disorders (SUDs) often co-occur, partly because they share risk factors. In this international multicenter study, risk factors for BPD were examined for SUD patients. In total, 1,205 patients were comprehensively examined by standardized interviews and questionnaires on psychiatric diagnosis and risk factors, and it was found that 1,033 (85.7%) had SUDs without BPD (SUD) and 172 (14.3%) had SUD with BPD (SUD + BPD). SUD + BPD patients were significantly younger, more often females and more often diagnosed with comorbid adult attention deficit/hyperactivity disorder. SUD + BPD patients did not differ from SUD patients on most risk factors typical for SUD such as maternal use of drugs during pregnancy or parents having any SUD. However, SUD + BPD patients did have a higher risk of having experienced emotional and physical abuse, neglect, or family violence in childhood compared to SUD patients, suggesting that child abuse and family violence are BPD-specific risk factors in patients with SUDs.

Spanish version of the Substance Use Risk Profile Scale: factor structure, reliability, and validity in Mexican adolescents

To validate the Substance Use Risk Profile Scale (SURPS) in a sample of Mexican adolescents, this brief 23-item self-report questionnaire has been developed to screen four high-risk personality traits for substance misuse, to guide targeted approaches to prevention of addictions in adolescents. The scale has been previously validated in United Kingdom, Canada, Sri Lanka and China. A sample of 671 adolescents aged 11-17 completed a Spanish translation of the SURPS as well as other measures of personality and substance use. The Spanish translation of the SURPS has moderate internal consistency, and demonstrated a four-factor structure very similar to the original scale. The four subscales show good concurrent validity and three of the subscales were found to correlate with measures of substance use. The Spanish translation of the SURPS seems to be a valid and sensitive scale that can be used in a Mexican adolescent population.

Characteristics of borderline personality disorder in a community sample: comorbidity, treatment utilization, and general functioning

This study provides estimates of the prevalence and demographic features of borderline personality disorder (BPD) in a community sample as well as BPD comorbidity rates with Axis I and II disorders. In addition, the authors provide data on general functioning and treatment seeking among individuals with BPD. Data from 34,481 participants in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were analyzed. Results suggest that 2.7% of adults in the United States meet diagnostic criteria for BPD, with slightly higher rates of the disorder in females, people in lower income brackets, people younger than 30, and individuals who are separated or divorced. Racial/ethnic differences were evident, with Native Americans (5.0%) and Blacks (3.5%) having significantly higher rates of the disorder, on average, and Asians having significantly lower rates (1.2%). Individuals with a BPD diagnosis were likely to have co-occurring lifetime mood disorders, anxiety disorders, substance use disorders, and other personality disorders. Specifically, 84.8% of individuals with BPD also had a lifetime anxiety disorder, 82.7% had a lifetime mood disorder/episode, and 78.2% were diagnosed with a lifetime substance use disorder. Individuals with BPD showed significant impairment in functioning and were highly likely to seek therapy or receive medication for mental health concerns.

A retrospective analysis focusing on a group of patients with dual diagnosis treated by both mental health and substance use services

OBJECTIVE

To highlight which demographic, familial, premorbid, clinical, therapeutic, rehabilitative, and assistance factors were related to dual diagnosis, which, in psychiatry, means the co-occurrence of both mental disorder and substance use in the same patient.

METHODS

Our sample (N=145) was chosen from all outpatients with a dual diagnosis treated from January 1, 2012 to July 31, 2012 by both the Mental Health Service and the Substance Use Service of Modena and Castelfranco Emilia, Italy. Patients who dropped out during the study period were excluded. Demographic data and variables related to familial and premorbid history, clinical course, rehabilitative programs, social support and nursing care, and outcome complications were collected. The patients' clinical and functioning conditions during the study period were evaluated.

RESULTS

Our patients were mostly men suffering from a cluster B personality disorder. Substance use was significantly more likely to precede psychiatric disease (P<0.001), and 60% of the sample presented a positive familial history for psychiatric or addiction disease or premorbid traumatic factors. The onset age of substance use was related to the period of psychiatric treatment follow-up (P<0.001) and the time spent in rehabilitative facilities (P<0.05), which, in turn, was correlated with personality disorder diagnosis (P<0.05). Complications, which presented in 67% of patients, were related to the high number of psychiatric hospitalizations (P<0.05) and professionals involved in each patient's treatment (P<0.05). Males more frequently presented familial, health, and social complications, whereas females more frequently presented self-threatening behavior (P<0.005).

CONCLUSION

It was concluded that the course of dual diagnosis may be chronic, severe, and disabling, requiring many long-term therapeutic and rehabilitative programs to manage various disabilities.

Borderline personality traits and substance use: genetic factors underlie the association with smoking and ever use of cannabis, but not with high alcohol consumption

Borderline personality disorder (BPD) and substance use disorders often co-occur. Both disorders are heritable and family studies showed that there are familial factors that increase the risk for BPD as well as substance use/abuse. This is the first study that investigates whether the association of borderline personality traits (BPT) with substance use reflects an underlying genetic vulnerability or nongenetic familial influences. To this end we analyzed data of 5,638 Dutch and Belgian twins aged between 21-50 years from 3,567 families. Significant associations between BPT and high alcohol consumption (r = .192), regular smoking (r = .299), and ever use of cannabis (r = .254) were found. Bivariate genetic analyses showed that the associations of BPT and substance use had different etiologies. For regular smoking and for ever use of cannabis, the correlation with BPT was explained by common genetic factors. Interestingly, for high alcohol consumption and BPT the association was explained by unique environmental factors that influence both traits rather than common genetic factors.

Sensitivity and specificity of a brief personality screening instrument in predicting future substance use, emotional, and behavioral problems: 18-month predictive validity of the Substance Use Risk Profile Scale

BACKGROUND

This study assessed the validity, sensitivity, and specificity of the Substance Use Risk Profile Scale (SURPS), a measure of personality risk factors for substance use and other behavioral problems in adolescence.

METHODS

The concurrent and predictive validity of the SURPS was tested in a sample of 1,162 adolescents (mean age: 13.7 years) using linear and logistic regressions, while its sensitivity and specificity were examined using the receiver operating characteristics curve analyses.

RESULTS

Concurrent and predictive validity tests showed that all 4 brief scales-hopelessness (H), anxiety sensitivity (AS), impulsivity (IMP), and sensation seeking (SS)-were related, in theoretically expected ways, to measures of substance use and other behavioral and emotional problems. Results also showed that when using the 4 SURPS subscales to identify adolescents "at risk," one can identify a high number of those who developed problems (high sensitivity scores ranging from 72 to 91%). And, as predicted, because each scale is related to specific substance and mental health problems, good specificity was obtained when using the individual personality subscales (e.g., most adolescents identified at high risk by the IMP scale developed conduct or drug use problems within the next 18 months [a high specificity score of 70 to 80%]).

CONCLUSIONS

The SURPS is a valuable tool for identifying adolescents at high risk for substance misuse and other emotional and behavioral problems. Implications of findings for the use of this measure in future research and prevention interventions are discussed.

Role of substance abuse comorbidity and personality on the outcome of depression in bipolar disorder: harm avoidance influences medium-term treatment outcome

Comorbid conditions are frequent in bipolar disorder (BD) and may complicate the treatment and course of illness. We investigated the role of substance use disorder (SUD), axis II personality disorders (PD) and continuous personality traits on the medium-term outcome (6 months) of treatment for bipolar depression. One hundred and thirty-nine BD patients meeting criteria for a depressive episode were included in the study. SUD and PD were diagnosed according to structured interviews. Personality dimensions were evaluated by the Temperament and Character Inventory. Depressive severity over time was evaluated by the Hamilton Rating Scale for Depression. Neither PD nor SUD influenced the outcome of depression. Variables independently associated with a poor outcome were a high baseline severity and high scores for the temperamental trait of Harm Avoidance. Though several limitations characterize the present study, neurotic personality traits seem to be associated with a slower recovery from depressive symptoms in BD, independently from their initial severity.

Distinguishing general and specific personality disorder features and implications for substance dependence comorbidity

Clinical and population-based samples show high comorbidity between Substance Use Disorders (SUDs) and Axis II Personality Disorders (PDs). However, Axis II disorders are frequently comorbid with each other, and existing research has generally failed to distinguish the extent to which SUD/PD comorbidity is general or specific with respect to both specific types of PDs and specific types of SUDs. We sought to determine whether ostensibly specific comorbid substance dependence-Axis II diagnoses (e.g., alcohol use dependence and borderline personality disorder) are reflective of more pervasive or general personality pathology or whether the comorbidity is specific to individual PDs. Face-to-face interview data from Wave 1 and Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions were analyzed. Participants included 34,653 adults living in households in the United States. We used hierarchical factor models to statistically partition general and specific personality disorder dimensions while simultaneously testing for specific PD-substance dependence relations. Results indicated that substance dependence-Axis II comorbidity is characterized by general (pervasive) pathology and by Cluster B PD pathology over and above the relationship to the general PD factor. Further, these relations between PD factors and substance dependence diagnoses appeared to largely account for the comorbidity among substance dependence diagnoses in the younger but not older participants. Our findings suggest that a failure to consider the general PD factor, which we interpret as reflecting interpersonal dysfunction, can lead to potential mischaracterizations of the nature of certain PD and SUD comorbidities.

Personality disorders and cigarette smoking among adults in the United States

INTRODUCTION

There is a paucity of empirical information pertaining to the association between personality disorders and cigarette smoking. The present study examined whether, and to what degree, personality disorders are associated with cigarette smoking; investigated the specificity of any observed smoking-personality disorder association; and the role of mood/anxiety disorders, substance use, and nicotine dependence in those relations.

METHODS

Data were drawn from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC), a nationally representative sample of 43,083 adults in the United States.

RESULTS

Results indicated a substantial percentage of those with personality disorders are nicotine dependent. Interestingly, the association between dependent, avoidant, histrionic, schizoid and paranoid personality disorders as well as former dependent smoking was partially explained by co-occurring mood/anxiety disorders, and adjusting for such clinical conditions appeared to generally attenuate the strength of many other associations. Finally, the association between personality disorders and smoking appears to differ by specific personality disorder, with some of the strongest relations being evident for antisocial personality disorder.

DISCUSSION

These novel empirical findings are discussed in relation to the relevance of cigarette smoking among those with personality disorders.

Predicting treatment outcome in stimulant dependence

The purpose of this review is to highlight some of the issues that need to be addressed to optimally use functional neuroimaging as a clinical tool to predict outcomes in substance use disorders. First, the importance of recognizing the clinical heterogeneity of the substance use disorders population is highlighted. We also emphasize that empirical and theoretical analyses support the idea that the courses of substance use disorders are relatively independent of the types of substance being used. Second, various approaches to the measurement and characterization of the longitudinal courses of substance use disorders are summarized. Third, predictors of outcomes are reviewed and their limitations are discussed. Within this context, we describe aspects of our work that focus on using functional magnetic resonance imaging to predict outcomes. Fourth, we discuss future directions, critical experiments, and the utility of functional neuroimaging as a clinical tool.

Reduced posterior mesofrontal cortex activation by risky rewards in substance-dependent patients

Substance-dependent individuals show disadvantageous decision-making, as well as alterated frontocortical recruitment when performing experimental tasks. We investigated whether substance-dependent patients (SDP) would show blunted recruitment of posterior mesofrontal cortex (PMC) by a conflict between concurrently increasing reward and risk of penalty in a monetary game of "chicken." SDP and controls performed: motor control (no reward) trials, guaranteed reward trials in which reward was not at risk, and risky trials where subjects were required to terminate their reward accrual before a secret varying time limit or else "bust" and forfeit that trial's winnings (low penalty) or the current trial's winnings plus an equal amount of previous winnings (high penalty). Reward accrual duration at risk of "busting" correlated negatively with trait neuroticism. The contrast between winning guaranteed reward versus non-reward activated the caudate head bilaterally in SDP but not controls. Accumulation of money at risk of low- or high-penalty (contrasted with accumulating guaranteed money) activated the PMC in both groups, but with a greater magnitude and more anterior extent in controls. Pre-decision signal increase in a PMC volume of interest negatively correlated with risk-taking in low-penalty trials, and was blunted in SDP relative to controls under both penalty conditions after controlling for individual differences in actual risk-taking and the higher neuroticism of SDP. These data suggest that SDP are characterized by a combination of: (a) striatal hypersensitivity to reward, and (b) under-recruitment of the specialized conflict-monitoring circuitry of the PMC when reward entails potential penalties.

Personality disorder symptoms, drinking motives, and alcohol use and consequences: cross-sectional and prospective mediation

Research shows high comorbidity between Cluster B personality disorders (PDs) and alcohol use disorders (AUDs). Studies on personality traits and alcohol use have identified coping and enhancement drinking motives as mediators in the relations among impulsivity, affective instability, and alcohol use. To the extent that PDs reflect extreme expression of these traits, drinking motives should mediate the relation between PD symptoms and alcohol involvement. This was tested using path models estimating the extent to which coping and enhancement drinking motives mediated the relation between Cluster B symptom counts and alcohol use and problems both concurrently and at a 5-year follow-up. Three hundred fifty-two adults participated in a multiwave study of risk for alcoholism (average age = 29 years at Wave 1). Enhancement motives mediated (a) the cross-sectional relation between Cluster B symptoms and drinking quantity/frequency, heavy drinking, total drinking consequences, dependence features, and AUD diagnosis and (b) the prospective relation to AUDs. Although coping motives mediated the relation between Cluster B symptoms and drinking consequences and dependence features cross-sectionally, prospective effects were limited to indirect effects through Time 1.

Social-emotion recognition in borderline personality disorder

Borderline personality disorder (BPD) is characterized by interpersonal disturbances, but the neurocognitive aspects of these symptoms are poorly understood. We hypothesized that patients with BPD have impaired perception of emotional expressions, which are related to symptoms of interpersonal dysfunction. To control potential confounding factors, this study excluded subjects with comorbid diagnoses known to be associated with impaired affect perception. We tested 43 outpatients with BPD and 26 healthy controls on emotion recognition tasks (facial, prosodic, and integrated facial/prosodic), nonemotional facial feature recognition, and interpersonal antagonism (Buss-Durkee Hostility Index). Patients with BPD showed normal ability to recognize isolated facial or prosodic emotions but had impaired recognition of emotions in integrated facial/prosodic stimuli, as well as impaired discrimination of nonemotional facial features. In patients with BPD, impaired recognition of integrated emotional stimuli was associated with interpersonal antagonism, particularly suspiciousness and assaultiveness. These results suggest that patients with BPD have deficits in higher order integration of social information, which may be related to some of the more serious symptoms of the disorder.

Antisocial personality and stress-induced brain activation in cocaine-dependent patients

We explore the neural correlates underlying distress processing in antisocial personality in cocaine-dependent individuals. Twenty-seven abstinent cocaine-dependent individuals took part in script-guided stress imagery in a functional magnetic resonance imaging study. Regional brain activation during stress imagery was compared with a baseline period, for male and female participants separately. Their California Psychological Inventory socialization scores were then correlated in region of interest analysis with corticolimbic brain regions that showed significant activation during stress. The effect size of activity change in the medial prefrontal cortex is associated with lower socialization score (i.e. greater sociopathy) and with the change in heart rate, but only among female participants. These results highlight important sex differences in the association between antisocial personality and distress processing in cocaine-dependent individuals.

Substance use disorders in men with antisocial personality disorder: a study in Turkish sample

This study investigated the prevalence of substance use disorders (SUDs) and "substance of choice" in 500 male Turkish psychiatric outpatients manifesting a DSM-IV diagnosed antisocial personality disorder (APD) and a SUD diagnoses (the Structured Clinical Interview for DSM-IV). Lifetime SUDs were diagnosed in 86% of APD subjects. Alcohol, cannabis, and inhalant use disorders were the most frequent among substance use, 75.6%, 67.4%, and 35.6%, respectively. This sample's "substance of choice" differed from reported Western populations; a result which may be influenced by socio-cultural variations. The study's limitations are noted.

Alcohol, tobacco, and drug use disorders and personality disorder symptoms

In a nonclinical sample of 395 young adults, the authors evaluated the relations between major personality traits, Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) personality disorder symptoms, and DSM-IV alcohol use disorders (AUDs). Consistent with previous findings, traits related to disinhibition and negative affectivity were consistently associated with AUDs, as were Cluster B personality disorder symptoms (especially antisocial and borderline disorder symptoms). Multivariate analyses revealed that Cluster B symptoms were significantly associated with AUDs above and beyond what was accounted for by personality traits. Further, the authors found differential patterns of relations between other substance use disorders (SUDs; i.e., tobacco dependence and drug use diagnoses) and personality disorder symptoms. Overall, these results suggest that personality disorder symptoms predict unique variance in SUDs that reflect maladaptive aspects of personality traits.