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BMC Psychiatry
Published in: BMC Psychiatry 1/2016

Open Access 01-12-2016 | Research article

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

Authors: Kristen L. McCarter, Sean A. Halpin, Amanda L. Baker, Frances J. Kay-Lambkin, Terry J. Lewin, Louise K. Thornton, David J. Kavanagh, Brian J. Kelly

Published in: BMC Psychiatry | Issue 1/2016

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Abstract

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.
Literature
1.
NSW Health Department. The management of people with a co-existing mental health and substance use disorder. Sydney: NSW Government; 2000.
2.
Mills KL, Deady M, Proudfoot H, Sannibale C, Teesson M, Mattick R, Burns L. Guidelines on the management of co-occurring alcohol and other drug and mental health conditions in alcohol and other drug treatment settings. Sydney: National Drug and Alcohol Research Centre; 2009.
3.
Slade T, Johnston A, Oakley Browne MA, Andrews G, Whiteford H. 2007 national survey of mental health and wellbeing: methods and key findings. Aust NZ J Psychiatry. 2009;43:594–605.CrossRef
4.
Slade T, Johnston A, Teesson M, Whiteford H, Burgess P, Pirkis J, Saw S. The mental health of Australians 2: report on the 2007 national survey of mental health and wellbeing. Canberra: Australian Government Department of Health and Ageing; 2009.
5.
Pennay A, Cameron J, Reichert T, Strickland H, Lee NK, Hall K, Lubman DI. A systematic review of interventions for co-occurring substance use disorder and borderline personality disorder. J Subst Abuse Treat. 2011;41:363–73.CrossRefPubMed
6.
Jackson HJ, Burgess PM. Personality disorders in the community: A report from the Australian National Survey of Mental Health and Wellbeing. Soc Psychiatry Psychiatr Epidemiol. 2000;35:531–8.CrossRefPubMed
7.
Grilo CM, Walker ML, Becker DF, Edell WS, McGlashan TH. Personality disorders in adolescents with major depression, substance use disorders, and coexisting major depression and substance use disorders. J Consult Clin Psychol. 1997;65:328–32.CrossRefPubMed
8.
Reich JH, Green AI. Effect of personality disorders on treatment outcome. J Nerv Ment Dis. 1991;179:74–82.CrossRefPubMed
9.
Trull TJ, Sher KJ, Minks-Brown C, Durbin J, Burr R. Borderline personality disorder and substance use disorders: a review and integration. Clin Psychol Rev. 2000;20:235–53.CrossRefPubMed
10.
Hirschfeld RMA. Personality disorders and depression: comorbidity. Depress Anxiety. 1999;10:142–6.CrossRefPubMed
11.
Newton-Howes G, Tyrer P, Johnson T. Personality disorder and the outcome of depression: meta-analysis of published studies. Br J Psychiatry. 2006;188:13–20.CrossRefPubMed
12.
Bowden-Jones O, Iqbal MZ, Tyrer P, Seivewright N, Cooper S, Judd A, Weaver T, the Cosmic study team. Prevalence of personality disorder in alcohol and drug services and associated comorbidity. Addiction. 2004;99:1306–14.CrossRefPubMed
13.
Grant B, Stinson F, Dawson D, Chou S, Dufour M, Compton W, Pickering R, Kaplan K. Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry. 2004;61:807–16.CrossRefPubMed
14.
Grant BF, Hasin DS, Stinson FS, Dawson DA, June RW, Goldstein B, Smith SM, Saha TD, Huand B. Prevalence, correlates, co-morbidity, and comparative disability of DSM-IV generalized anxiety disorder in the USA: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychol Med. 2005;35:1747–59.CrossRefPubMed
15.
Sher KJ, Trull TJ. Substance use disorder and personality disorder. Curr Psychiatry Rep. 2002;4:25–9.CrossRefPubMed
16.
Paris J. Gender differences in personality traits and disorders. Curr Psychiatry Rep. 2004;6:71–4.CrossRefPubMed
17.
Gianoli MO, Jane JS, O’Brien E, Ralevski E. Treatment for comorbid borderline personality disorder and alcohol use disorders: a review of the evidence and future recommendations. Exp Clin Psychopharmacol. 2012;20:333–44.CrossRefPubMedPubMedCentral
18.
19.
Furnham A, Milner R, Akhtar R, Fruyt FD. A review of the measures designed to assess DSM-5 personality disorders. Psychology. 2014;5:41.
20.
Lewin TJ, Slade T, Andrews G, Carr VJ, Hornabrook CW. Assessing personality disorders in a national mental health survey. Soc Psychiatry Psychiatr Epidemiol. 2005;40:87–98.CrossRefPubMed
21.
Slade T. The descriptive epidemiology of internalizing and externalizing psychiatric dimensions. Soc Psychiatry Psychiatr Epidemiol. 2007;42:554–60.CrossRefPubMed
22.
Andrews G, editor. Management of Mental Disorders. 4th ed. Sydney: The World Health Organization Collaborating Centre for Mental Health and Substance Abuse; 2004.
23.
Brown RA, Evans MD, Miller IW, Burgess ES, Mueller TI. Cognitive-behavioral treatment for depression in alcoholism. J Consult Clin Psychol. 1997;65:715–26.CrossRefPubMedPubMedCentral
24.
Cornelius JR, Douaihy A, Bukstein OG, Daley DC, Wood SD, Kelly TM, Salloum IM. Evaluation of cognitive behavioral therapy/motivational enhancement therapy (CBT/MET) in a treatment trial of comorbid MDD/AUD adolescents. Addict Behav. 2011;36:843–8.CrossRefPubMedPubMedCentral
25.
Kay-Lambkin PIDJ, Baker AL, Lewin TJ, Carr VJ. Computer-based psychological treatment for comorbid depression and problematic alcohol and/or cannabis use: A randomized controlled trial of clinical efficacy. Addiction. 2009;104:378–88.CrossRefPubMed
26.
Lydecker KP, Tate SR, Cummins KM, McQuaid J, Granholm E, Brown SA. Clinical outcomes of an integrated treatment for depression and substance use disorders. Psychol Addict Behav. 2010;24:453–65.CrossRefPubMedPubMedCentral
27.
Kelly TM, Daley DC, Douaihy AB. Treatment of substance abusing patients with comorbid psychiatric disorders. Addict Behav. 2012;37:11–24.CrossRefPubMed
28.
Baker AL, Kavanagh DJ, Kay-Lambkin FJ, Hunt SA, Lewin TJ, Carr VJ, Connolly J. Randomized controlled trial of cognitive-behavioural therapy for coexisting depression and alcohol problems: Short-term outcome. Addiction. 2010;105:87–9.CrossRefPubMed
29.
Ekleberry SC. Integrated Treatment for Co-Occurring Disorders: Personality Disorders and Addiction. Hoboken: Taylor & Francis; 2008.
30.
Bakken K, Landheim A, Vaglum P. Axis I and II disorders as long-term predictors of mental distress: a six-year prospective follow-up of substance-dependent patients. BMC Psychiatry. 2007;7:29.CrossRefPubMedPubMedCentral
31.
Langas A-M, Malt U, Opjordsmoen S. In-depth study of personality disorders in first-admission patients with substance use disorders. BMC Psychiatry. 2012;12:180.CrossRefPubMedPubMedCentral
32.
Ross S, Dermatis H, Levounis P, Galanter M. A comparison between dually diagnosed inpatients with and without Axis II comorbidity and the relationship to treatment outcome. Am J Drug Alcohol Abuse. 2003;29:263–79.CrossRefPubMed
33.
Piñeiro B, Fernández del Río E, López-Durán A, Martínez Ú, Becoña E. The association between probable personality disorders and smoking cessation and maintenance. Addict Behav. 2013;38:2369–73.CrossRefPubMed
34.
Reich JH, Vasile RG. Effect of personality disorder on the treatment outcome of Axis I conditions: An update. J Nerv Ment Dis. 1993;181:475–84.CrossRefPubMed
35.
Longabaugh R, Rubin A, Malloy P, Beattie M, Clifford PR, Noel N. Drinking outcomes of alcohol abusers diagnosed as Antisocial Personality Disorder. Alcohol Clin and Exp Res. 1994;18:778–85.CrossRef
36.
Messina NP, Wish ED, Hoffman JA, Nemes S. Antisocial personality disorder and TC treatment outcomes. Am J Drug Alcohol Abuse. 2002;28:197–212.CrossRefPubMed
37.
Verheul R, van den Bosch LMC, Ball SA. Substance abuse. In: Oldham JM, Skodol AE, Bende DS, editors. Textbook of personality disorders. Washington, DC: American Psychiatric Publishing; 2005. p. 463–75.
38.
Baker AL, Kavanagh DJ, Kay-Lambkin FJ, Hunt SA, Lewin TJ, Carr VJ, McElduff P. Randomized controlled trial of MICBT for co-existing alcohol misuse and depression: Outcomes to 36-months. J Subst Abuse Treat. 2014;46:281–90.CrossRefPubMed
39.
Kay-Lambkin FJ, Baker AL, Kelly B, Lewin TJ. Clinician-assisted computerised versus therapist-delivered treatment for depressive and addictive disorders: A randomised controlled trial. Med J Aust. 2011;195:44–50.
40.
Kay-Lambkin F, Edwards S, Baker A, Kavanagh D, Kelly B, Bowman J, Lewin T. The impact of tobacco smoking on treatment for comorbid depression and alcohol misuse. Intl J Ment Health Addict. 2013;11:619–33.CrossRef
41.
Handley TE, Kay-Lambkin FJ, Baker AL, Lewin TJ, Kelly BJ, Inder KJ, Attia JR, Kavanagh DJ. Incidental treatment effects of CBT on suicidal ideation and hopelessness. J Affect Disord. 2013;151:275–83.CrossRefPubMed
42.
Handley TE, Kay-Lambkin FJ, Baker AL, Lewin TJ, Kelly BJ, Inder KJ, Attia JR, Kavanagh DJ. Investigation of a suicide ideation risk profile in people with co-occurring depression and substance use disorder. J Nerv Ment Dis. 2016. In Press.
43.
Thornton LK, Baker AL, Johnson MP, Kay-Lambkin F, Lewin TJ. Reasons for substance use among people with psychotic disorders: Method triangulation approach. Psychol Addict Behav. 2012;26:279–88.CrossRefPubMed
44.
First MB, Spitzer RL, Gibbon M, Williams JB. Structured Clinical Interview for DSM-IV-TR axis I disorders (SCID), research version, patient edition. New York: Biometrics Research, New York State Psychiatric Institute; 2001.
45.
Darke S, Hall W, Wodak A, Heather N, Ward J. Development and validation of a multi-dimensional instrument for assessing outcome of treatment among opiate users: The Opiate Treatment Index (OTI). Br J Addict. 1992;87:733–42.CrossRefPubMed
46.
Beck AT, Steer RA, Brown GK. The Beck Depression Inventory (BDI-II), Second Edition: Manual. San Antonio: The Psychological Corporation; 1996.
47.
American Psychiatric Association. Global Assessment of Functioning (GAF) Scale, Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: APA; 2000.
48.
Loranger AW, Janca A, Sartorius N. The ICD-10 International Personality Disorder Examination (IPDE). Cambridge: Cambridge University Press; 1997.CrossRef
49.
Shea MT, Widiger TA, Klein MH. Comorbidity of personality disorders and depression: Implications for treatment. J Consult Clin Psychol. 1992;60:857–68.CrossRefPubMed
50.
National Health and Medical Research Council [NHMRC]. Australian guidelines to reduce health risks from drinking alcohol. Canberra: NHMRC; 2009.
51.
Baker AL, Bucci S, Lewin TJ, Kay-Lambkin F, Constable PM, Carr VJ. Cognitive behavioural therapy for substance use disorders in people with psychotic disorders: Randomised controlled trial. Br J Psychiatry. 2006;188:439–48.CrossRefPubMed
52.
Baker AL, Lee NK, Claire M, Lewin TJ, Grant T, Pohlman S, Saunders JB, Kay-Lambkin F, Constable P, Jenner L et al. Drug use patterns and mental health of regular amphetamine users during a reported ‘heroin drought’. Addiction. 2004;99:875–84.CrossRefPubMed
53.
Morley KC, Baillie A, Leung S, Sannibale C, Teesson M, Haber PS. Is specialized integrated treatment for comorbid anxiety, depression and alcohol dependence better than treatment as usual in a public hospital setting? Alcohol Alcohol. 2016;51:402–409.
54.
Skodol AE, Gunderson JG, McGlashan TH, Dyck IR, Stout RL, Bender DS, Grilo CM, Shea MT, Zanarini MC, Morey LC et al. Functional impairment in patients with schizotypal, borderline, avoidant, and obsessive-compulsive personality disorder. Am J Psychiatry. 2002;159:276–83.CrossRefPubMed
55.
Bender DS, Dolan RT, Skodol AE, Sanislow CA, Dyck IR, McGlashan TH, Shea MT, Zanarini MC, Oldham JM, Gunderson JG. Treatment utilization by patients with personality disorders. Am J Psychiatry. 2001;158:295–302.CrossRefPubMed
56.
Gold LH. DSM-5 and the assessment of functioning: The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). J Am Acad Psychiatry Law. 2014;42:173–81.PubMed
57.
Startup M, Jackson MC, Bendix S. The concurrent validity of the Global Assessment of Functioning (GAF). Br J Clin Psychol. 2002;41:417–22.CrossRefPubMed
58.
Metadata
Title
Associations between personality disorder characteristics and treatment outcomes in people with co-occurring alcohol misuse and depression
Authors
Kristen L. McCarter
Sean A. Halpin
Amanda L. Baker
Frances J. Kay-Lambkin
Terry J. Lewin
Louise K. Thornton
David J. Kavanagh
Brian J. Kelly
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2016
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-016-0937-z

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