Top

International Journal of Mental Health and Addiction

Published in:

01-01-2008

Screening and Assessment of Personality Disorders in Addiction Treatment Settings

Authors: Shelley McMain, Michael Ellery

Published in: International Journal of Mental Health and Addiction | Issue 1/2008

Abstract

Given the high rates of overlap between personality disorders and substance use disorders and the associated high levels of disability, a thorough diagnostic assessment involving screening for personality pathology should be routinely done with people seeking treatment for addiction problems. Evaluating whether a person meets diagnostic criteria for an Axis II disorder is essential, since specific diagnoses, such as borderline personality disorder, are linked to preferred treatment approaches. Screening is integral to the detection and treatment of problems faced by people with concurrent personality disorders and substance use disorders. However, as screens tend to overestimate the presence of personality disorder traits, diagnostic assessment is necessary to accurately determine the presence or absence of a personality disorder and to specify the contribution of a concurrent personality disorder to the problems being experienced by someone with a substance use disorder. This paper reviews the psychometrics of several instruments for the screening and diagnosis of personality disorders, which may be useful in addiction treatment settings.

American Psychiatric Association (1987). Diagnostic and statistical manual of mental disorders, 3rd ed, revised (DSM-III-R). New York: American Psychiatric Press.

American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders, 4th ed (DSM-IV). New York: American Psychiatric Press.

Appleby, L., Dyson, V., Altman, E., & Luchins, D. J. (1997). Asessing substance use in multiproblem patients: Reliability and validity of the Addiction Severity Index in a mental hospital population. Journal of Nervous & Mental Disease, 185, 159–165.CrossRef

Arntz, A., van den Hoorn, M., Cornelis, J., Verheul, R., van den Bosch, W. M., & de Bie, A. J. (2003). Reliability and validity of the borderline personality disorder severity index. American Journal of Psychiatry, 143(4), 519–522.

Barratt, E. S. (1959). Anxiety and impulsiveness related to psychomotor efficiency. Perceptual and Motor Skills, 9, 191–198.CrossRef

Barratt, E. S. (1985). Impulsiveness subtraits: arousal and information processing. In J. T. I. C. E. Spence (Ed.), Motivation, emotion, and personality (pp. 137–146). North Holland: Elsevier.

Boone, D. (1998). Internal consistency reliability of the Personality Assessment Inventory with psychiatric inpatients. Journal of Clinical Psychology, 54, 839–843.PubMedCrossRef

Brooner, R. K., King, V. L., Kidorf, M., & Schmidt, C. W. J. (1997). Psychiatric and substance use comorbidity among treatment-seeking opioid abusers. Archives of General Psychiatry, 54, 71–80.PubMed

Cacciola, J. S., Rutherford, M. J., Alterman, A. I., McKay, J. R., & Snider, E. (1996). Personality disorders and treatment outcome in methadone maintenance patients. Journal of Nervous & Mental Disease, 184, 234–239.CrossRef

Darke, S., Williamson, A., Ross, J., Teesson, M., & Lynskey, M. (2003). Borderline personality disorder, antisocial personality disorder and risk-taking among heroin users: findings from the Australian Treatment Outcome Study (ATOS). Drug & Alcohol Dependence, 74, 77–83.CrossRef

Darke, S., Williamson, A., Ross, J., Teesson, M., & Lynskey, M. (2004). Borderline personality disorder, antisocial personality disorder and risk-taking among heroin users: findings from the Australian Treatment Outcome Study (ATOS). Drug & Alcohol Dependence, 74, 77–83.CrossRef

DeJong, C. A., van den Brink, W., Harteveld, F. M., & Van der Wielen, E. G. (1993). Personality disorders in alcoholics and drug addicts. Comprehensive Psychiatry, 34, 87–94.PubMedCrossRef

Dulit, R. A., Fyer, M. R., Haas, G. L., Sullivan, T., & Frances, A. J. (1990). Substance use in borderline personality disorder. American Journal of Psychiatry, 147, 1002–1007.PubMed

First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1995). Structured clinical interview for axis I DSM-IV disorders—patient edition (SCID-I/P). New York: Biometrics Research Department, NY Sate Psychiatric Institute.

Grant, B. F., Stinson, F., Dawson, D., Chou, S. P., Ruan, J., & Pickering, R. (2004). Co-occurrence of 12-month alcohol and drug use disorders and personality disorders in the United States. Archives of General Psychiatry, 61, 361–368.PubMedCrossRef

Hare, R. D. (2003). The Hare psychopathy checklist—revised. Toronto, Ontario, Canada: Multi-health Systems.

Hart, S. D., Cox, D., & Hare, R. D. (1995). Manual for the psychopathy checklist: Screening version (PCL:SV). Toronto, Ontario, Canada: Multi-Health Systems.

Hasin, D., Samet, S., Nunes, E., Meydan, J., Matseoane, K., & Waxman, R. (2006). Diagnosis of comorbid psychiatric disorders in substance users assessed with psychiatric research interview for substance and mental disorders for DSM-IV. American Journal of Psychiatry, 163, 689–696.PubMedCrossRef

Health Canada (2002). Best practices: Concurrent mental health and substance use disorders. Ottawa, Canada: Health Canada.

Hodgins, D. C., & El-Guebaly, N. (1992). More data on the Addiction Severity Index: Reliability and validity with the mentally ill substance abuser. Journal of Nervous & Mental Disease, 180, 197–201.CrossRef

Hyler, S. E., Skodol, A. E., Kellman, H. D., Oldham, J., & Rosnick, L. (1990). The validity of the Personality Diagnostic Questionnaire: A comparison with two structured interviews. American Journal of Psychiatry, 147, 1043-1048.

Hyler, S. E., Skodol, A. E., Oldham, J. M., Kellman, H. D., & Doidge, N. (1992). The validity of the PDQ-R: A replication in an out-patient sample. Comprehensive Psychiatry, 33, 73-77.

Hyler, S. E., Rieder, R. O., Williams, J. B. W., Spitzer, R. L., Hendler, J., & Lyons, M. (1988). The Personality Diagnostic Questionnaire: Development and preliminary results. Journal of Personality Disorders, 2, 229–237.

Inman, D. J., Bascue, L. O., & Skoloda, T. (1985). Identification of borderline personality disorder among substance abuse inpatients. Journal of Substance Abuse Treatment, 2, 229–232.PubMedCrossRef

Kosten, R. A., Kosten, T. R., & Rounsaville, B. J. (1989). Personality disorders in opiate addicts show prognostic specificity. Journal of Substance Abuse Treatment, 6, 163–168.PubMedCrossRef

Kosten, T. R., Rounsaville, B. J., & Kleber, H. D. (1983). Concurrent validity of the Addiction Severity Index. Journal of Nervous & Mental Disease, 171, 606–610.CrossRef

Kranzler, H. R., Kadden, R. M., Babor, T. F., Tennen, H., & Rounsaville, B. J. (1996). Validity of the SCID in substance abuse patients. Addiction, 91, 859–868.PubMedCrossRef

Linehan, M. M. (1993a). Cognitive behavioral treatment of borderline personality disorder. New York: Guilford.

Linehan, M. M. (1993b). The skills training manual for treating borderline personality disorder. New York: Guilford.

Linehan, M. M., Dimeff, L. A., Reynolds, S. K., Comtois, K. A., Welch, S. S., & Heagerty, P., et al. (2002). Dialectal behavior therapy versus comprehensive validation therapy plus 12-step for the treatment of opioid dependent women meeting criteria for borderline personality disorder. Drug and Alcohol Dependence, 67, 13–26.PubMedCrossRef

Linehan, M. M., Schmidt, H., III, Dimeff, L. A., Craft, J. C., Kanter, J., & Comtois, K. A. (1999). Dialectical behavior therapy for patients with borderline personality disorder and drug-dependence. The American Journal on Addictions, 8(4), 279–292.PubMedCrossRef

Links, P. S., Heslegrave, R. J., Mitton, J. E., & van Reekum, R. (1995a). Borderline psychopathology and recurrences of clinical disorders. Journal of Nervous and Mental Disease, 183, 582–586.PubMedCrossRef

Links, P. S., Heslegrave, R. J., Ronald, J., Mitton, J. E., van Reekum, R., & Patrick, J. (1995b). Borderline personality disorder and substance abuse: Consequences of comorbidity. Canadian Journal of Psychiatry, 40, 9–14.

Links, P. S., Mitton, J. E., & Patrick, J. (1995c). Borderline personality disorder and the family environment. Canadian Journal of Psychiatry, 40, 218–219.

Loranger, A. W. (1995). International personality disorder examination (IPDE) manual. White Plains, NY: Cornell Medical Center.

Loranger, A. W., Sartorius, N., Andreoli, A., Berger, P., Buchheim, P., & Channabasavanna, S. M., et al. (1994). The International Personality Disorder Examination: The World Health Organization/Alcohol, Drug Abuse, and Mental Health Administration international pilot study of personality disorders. Archives of General Psychiatry, 51, 215–224.PubMed

Malow, R. M., West, J. A., Williams, J. L., & Sutker, P. B. (1989). Personality disorders classification and symptoms in cocaine and opioid addicts. Journal of Consulting and Clinical Psychology, 57, 765–767.PubMedCrossRef

McLellan, A. T., Kushner, H., Metzger, D., Peters, F., Smith, I., & Grissom, G., et al. (1992). The fifth edition of the Addiction Severity Index. Journal of Substance Abuse Treatment, 9, 199–213.PubMedCrossRef

McLellan, A. T., Luborsky, L., Woody, G. E., & O’Brien, C. P. (1980). An improved diagnostic evaluation instrument for substance abuse patients: The Addiction Severity Index. Journal of Nervous & Mental Disease, 168, 26–33.CrossRef

McMain, S., Korman, L., Blak, T., Dimeff, L., Collis, R., & Beadnell, B. (2004). Dialectical behaviour therapy for substance users with borderline personality disorder: A randomized controlled trial in Canada. In New Orleans: Association for the Advancement of Behavior Therapy Annual Meeting.

Miller, F. T., Abrams, T., Dulit, R., & Minna, F. (1993). Substance abuse in Borderline Personality Disorder. American Journal of Drug and Alcohol Abuse, 19, 491–497.PubMedCrossRef

Morey, L. C. (1991). The personality assessment inventory professional manual. Odessa, FL: Psychological Assessment Resources.

Nace, E. P., Davis, C. W., & Gaspari, J. P. (1991). Axis II comorbidity in substance abusers. American Journal of Psychiatry, 148, 120.

Nace, E. P., Saxon, J. J., & Shore, N. (1983). A comparison of borderline and nonborderline alcoholic patients. Archives of General Psychiatry, 40, 54–56.PubMed

Patton, J. H., Stanford, M. S., & Barratt, E. S. (1995). Factor structure of the Barratt Impulsiveness Scale. Journal of Clinical Psychology, 51, 768–774.PubMedCrossRef

Pettinati, H. (1991). Diagnosing personality disorders in substance abusers. NIDA Research Monograph, 105, 236–242.

Regier, D. A., Farmer, M., Rae, D., Locke, B., Keith, S., & Judd, L., et al. (1990). Comorbidity of mental disorders with alcohol and other drug abuse: results from the Epidemiologic Catchment Area (ECA) study. The Journal of the American Medical Association, 264, 2511–2518.CrossRef

Rutherford, M. J., Cacciola, J. S., & Alterman, A. I. (1994). Relationships of personality disorders with problem severity in methadone abusers. Drug and Alcohol Dependence, 35, 76.CrossRef

Shane, P. A., Jasiukaitis, P., & Green, R. S. (2003). Treatment outcomes among adolescents with substance abuse problems: The relationship between comorbidities and post-treatment substance involvement. Evaluation and Program Planning, 26, 393–402.CrossRef

Skodol, A. E., Oldham, J. M., & Gallaher, P. E. (1999). Axis II comorbidity of substance use disorders among patients referred for treatment of personality disorders. American Journal of Psychiatry, 156, 733–738.PubMed

Spitzer, R. L., Williams, J. B. W., Gibbon, M., & First, M. B. (1992). The Structured Clinical Interview for DSM-III-R: I. History, rationale, and description. Archives of General Psychiatry, 49, 624–629.PubMed

Stanford, M. S., Greve, K. W., & Dickens, T. J. (1995). Irritability and impulsiveness: Relationship to self-reported impulsive aggression. Personality and Individual Differences, 19(5), 757–760.CrossRef

Stone, M. H. (1990). The fate of borderline patients: Successful outcome and psychiatric practice. New York: Guilford Press.

Suris, A., Lind, L., Emmett, G., Borman, P. D., Kashner, M., & Barratt, E. S. (1995). Measures of aggressive behavior: Overview of clinical and research instruments. Aggression and Violent Behavior, 9, 165–227.CrossRef

Thomas, V., Melchert, T., & Banken, J. (1999). Substance dependence and personality disorders: Comorbidity and treatment outcome in an inpatient treatment population. Journal of Studies on Alcohol, 60, 271–277.PubMed

Trull, T. J., Sher, K., Minks-Brown, C., Durbin, J., & Burr, R. (2000). Borderline personality disorder and substance use disorders: A review and integration. Clinical Psychology Review, 20, 235–253.PubMedCrossRef

Vaglum, S. & Vaglum, P. (1985). Borderline and other mental disorders in alcoholic female psychiatric patients: A case control study. Journal of Psychopathology and Behavioral Assessment, 18, 50–60.

van den Bosch L. M., Louisa M. C., Verheul, R., & van den Brink, W. (2001). Substance abuse in borderline personality disorder: Clinical and etiological correlates. Journal of Personality Disorders, 15(5), 416–424.PubMedCrossRef

Verheul, R., van den Bosch, L. M. C., Koeter, M. W. J., de Ridder, M. A. J., Stijnen, T., & van den Brink, W. (2003). Dialectical behaviour therapy for women with borderline personality disorder: 12-month, randomised clinical trial in the Netherlands. British Journal of Psychiatry, 182, 135–140.PubMedCrossRef

Verheul, R., van den Brink, W., & Hartgers, C. (1995). Prevalence of personality disorders among alcoholics and drug addicts: An overview. European Addiction Research, 1, 166–177.CrossRef

Weiss, R. D., Mirin, S. M., Griffin, M. L., Gunderson, J. G., & Hufford, C. (1993a). Personality disorders in cocaine dependence. Comprehensive Psychiatry, 34, 145–149.PubMedCrossRef

Weiss, R. D., Mirin, S. M., Griffin, M. L., Gunderson, J. G., & Hufford, C. (1993b). Personality disorders in opiate addicts show prognostic specificity. Comprehensive Psychiatry, 34, 145–149.PubMedCrossRef

Widiger, T. A., & Frances, A. J. (1987). In A. Tasman, R. E. Hales, & A. Frances (Eds.), Epidemiology, diagnosis and comorbidity of borderline personality disorders (pp. 8–24). Washington, D.C.: American Psychiatric Press.

Williams, J. B. W., Gibbon, M., First, M. B., Spitzer, R. L., Davis, M., & Borus, J., et al. (1992). The Structured Clinical Interview for DSM-III (SCID). Multi-site test–retest reliability. Archives of General Psychiatry, 49, 630–636.PubMed

World Health Organization (1990). International statistical classification of diseases and related health problems, tenth revision (ICD-10). Geneva, Switzerland: World Health Organization.

Zanarini, M. C., Gunderson, J. G., Frankenburg, F. R., & Chauncey, D. L. (1989). The revised diagnostic interview for borderlines: discriminating borderline personality disorder from other axis II disorders. Journal of Personality Disorders, 3, 10–18.

Zimmerman, M. (1994). Diagnosing personality disorders: A review of issues and research methods. Archives of General Psychiatry, 51, 225–245.PubMed

Title: Screening and Assessment of Personality Disorders in Addiction Treatment Settings
Authors: Shelley McMain
Michael Ellery
Publication date: 01-01-2008
Publisher: Springer-Verlag
Published in: International Journal of Mental Health and Addiction / Issue 1/2008
Print ISSN: 1557-1874
Electronic ISSN: 1557-1882
DOI: https://doi.org/10.1007/s11469-007-9093-5

At a glance: The STEP trials

Springer Medicine

Screening and Assessment of Personality Disorders in Addiction Treatment Settings

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2008

Screening and Treating Mental Disorders in Addiction Treatment Settings: A Stepped Care Model

Panel Commentary: Clinical and Training and Knowledge Exchange Implications

Screening of Mental Disorders Among Clients with Addictions. The Need for Population-Specific Validation

Audience Discussion

Panel Commentary: Screening Applications

Audience Discussion