Personality disorders and substance abuse: By patterns of comorbidity in an inpatient treatment population
Thomas, Vicki H
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The primary goal of this study was to describe a sample of patients from an inpatient chemical dependency treatment program in terms of demographic characteristics, drugs of choice, and comorbid personality disorders. The various relationships among these variables and the effects of these variables on participation in aftercare treatment were also investigated. Personality disorders and psychoactive substance use disorders were diagnosed for 252 consecutively admitted patients in an inpatient chemical dependency unit using the Structured Clinical Interviews for DSM-III-R (SCID-P & SCID-II). Fifty-one percent (n=129) of the patients were diagnosed with one or more personality disorders and 37% (n=48) had two or more personality disorders diagnosed. The most frequently diagnosed personality disorders were: antisocial (17.9%), avoidant (9.9%), borderline (9.5%), narcissistic (9.1%), and obsessive-compulsive (7.1%). No consistent relationships between drug of choice and personality disorders diagnoses were found. Gender and age differences, however, were significant. Women were less likely than men to identify alcohol as their drug of choice and they were more likely than men to identify sedatives or opioid drugs. Cocaine was more frequently identified as the drug of choice by younger participants, whereas opioid drugs were more often identified as the drug of choice of the older participants. Several individual predictors of aftercare treatment participation were identified. The likelihood of early treatment dropout increased significantly with the diagnosis of a personality disorder. In the follow-up sample (n=104) only 6% (n=l) of the patients with more than one personality disorder remained in aftercare treatment at the end of the one year follow-up period. Cocaine use was also associated with aftercare treatment drop-out. Eighty-two percent (n=14) of the individuals identifying cocaine as their drug of choice dropped out of aftercare treatment within one month after discharge. Although several patterns of comorbidity and ideas for future research were identified, no efficient alternative to individual assessment and treatment planning emerged.