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International Journal of Mental Health and Addiction

Published in:

01-10-2017 | Original Article

The Impact of Personality Disorders and Severity of Dependence in Psychosocial Problems

Authors: Antonio Vélez-Moreno, Antonio J. Rojas, Francisco Rivera, Fermín Fernández-Calderón, Esperanza Torrico-Linares, Juan Ramírez-López, Francisco González-Saiz, Óscar M. Lozano

Published in: International Journal of Mental Health and Addiction | Issue 5/2017

Abstract

The comorbidity between Personality Disorders and Substance Use Disorders is well documented. Relationships between these two mental disorders are complex, and their concomitance generates poorer therapeutic prognosis and more severe psychosocial problems than either disorder alone. The purpose of this study was to compare three models of the relationship between personality disorders, substance use disorders and substance-related problems. Substance use disorder patients (n = 199) were recruited from outpatient centers for drug abuse care. The International Personality Disorder Examination Screening Questionnaire, European Addiction Severity Index and Substance Dependence Severity Scale were administered. For statistical analysis, t test, Pearson correlations and structural equation models were used. Patients with comorbidity showed more severe substance use disorder and more substance-related problems than patients without comorbidity. The three models fit well to the data, but two model with the effect mediation of severity of substance dependence between personality disorders and substance-related problems explained more variance observed. Considering the impact of personality disorders on family/social functioning, legal status and employment in these patients, integrated treatment models are needed to provide efficient care.

Arias, F., Szerman, N., Vega, P., Basurte, I., Morant, C., Ochoa, E., Poyo, F., & Babín, F. (2013). Estudio Madrid sobre prevalencia y características de los pacientes con patología dual en tratamiento en las redes de salud mental y de atención al drogodependiente. Adicciones, 25, 118–127.

Babor T. F. (1992). Substance-related problems in the context of international classificatory systems. In, Malcolm Lader, Griffith Edwards, D. Colin Drummond. The Nature of alcohol and drug related problems. Oxford University Press, New York.

Ball, S., Carroll, K., Canning-Ball, M., & Rounsaville, B. J. (2006). Reasons for dropout drug abuse treatment: symptoms, personality and motivation. Addictive Behaviors, 31, 320–330. doi:10.1016/j.addbeh.2005.05.013.CrossRefPubMed

Bentler P. M. (2003). EQS structural equations program for windows (Vers. 6.1 Beta Build 70) [Computer Software]. Encino, CA: Multivariate Software.

Bobes, J., González, M. P., Sáiz, P. A. & Bousolo M. (1996). Índice europeo de severidad de la adicción: EuropASI. Versión española. In Actas de la IV Reunión Interregional de Psiquiatría: 201–218.

Bradizza, C. M., Stasiewicz, P. R., & Paas, N. D. (2006). Relapse to alcohol and drug use among individuals diagnosed with co-ocurring mental health and substance use diorders: a review. Clinical Psychology Review, 26, 162–178. doi:10.1016/j.cpr.2005.11.005.CrossRefPubMed

Carrà, G., Scioli, R., Monti, M. C., Marinoni, A. (2006). Severity profiles of substance-abusing patients in Italian community addiction facilities: influence of psychiatric concurrent disorders. European Addiction Research, 12, 96–101.

Combaluzier, S., Gouvernet, B., & Bernoussi, A. (2009). Impact of personality disorders in a sample of 212 homeless drug users. Encephale, 35(5), 448–453. doi:10.1016/j.encep.2008.06.009.CrossRefPubMed

Drummond D. C. (1992). Problems and dependence: chalk and cheese or bread and butter? In, Lader M., Edwards C., Drummond C. The Nature of alcohol and drug related problems. Oxford University Press, New York.

Edwards, G., & Gross, M. (1976). Alcohol dependence: provision description of a clinical syndrome. British Medical Journal, 1, 1058–1061.CrossRefPubMedPubMedCentral

Fenton, M. C., Keyes, K., Geler, T., Greenstein, E., Skodol, A., Krueger, B., Grant, B., & Hasin, D. (2012). Psychiatric comorbidity and the persistence of drug use disorders in the United States. Addiction, 107, 599–609. doi:10.1111/j.1360-0443.2011.03638.x.CrossRefPubMedPubMedCentral

Fernández del Río, E., Martínez, C., & Becoña, E. (2011). Concordancia entre el cuesitonario de cribado del IPDE y el diagnostic de trastornos de la personalidad en fumadores. Psicología Conductual, 19(2), 303–315.

Flynn, P. M., & Brown, B. (2008). Co-ocurring disorders in substance abuse treatment: issues and prospects. Journal of Subtance Abuse Treatment,, 34, 36–47. doi:10.1016/j.jsat.2006.11.013.CrossRef

Fureman, B., Parikh, G., Braga, A., & McLellan, A. T. (1990). Addiction Severity Index: A guide to training and supervising ASI interviews based on the past ten years (Fifth edition). Pennsylvania: The University of Pennsylvania/Veterans Administration, Center for Studios of Addiction.

Gerstley, L., McLellan, A. T., Alterman, A. I., Woody, G. E., Luborsky, L., & Prout, M. (1989). Ability to form an alliance with the therapist: a possible marker of prognosis form patients with antisocial personality disorder. American Journal of Psychiatry, 146, 508–512.CrossRefPubMed

Hasin, D., Fenton, M. C., Skodol, A., Krueger, R., Keyes, K., Geier, T., Greenstein, E., Blanco, C., & Grant, B. (2011). Personality disorders and the 3-year course of alcohol, drug and nicotine use disorders. Archive of General Psychiatry, 68, 1158–1167. doi:10.1001/archgenpsychiatry.2011.78.CrossRef

Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55. doi:10.1080/10705519909540118.CrossRef

Jackson, K. M., Sher, K. J., & Wood, P. K. (2000). Trajectories of concurrent substance use disorders: a developmental, typological approach to comorbidity. Alcoholism, Clinical and Experimental Research, 24, 902–913.CrossRefPubMed

Jahng, S., Trull, T., Wood, P., Tragesser, S. L., Tomko, R., Grant, J., Bucholz, K., & Sher, K. (2011). Distinguishing general and specific personality disorder features and implications for substance dependence comorbidity. Journal of Abnormal Psychology, 120(3), 656–669. doi:10.1037/a0023539.CrossRefPubMedPubMedCentral

Jané-Llopis, E., & Matytsina, I. (2006). Mental health and alcohol, drugs and tobacco. A review of the comorbidity between mental disorders and the use of alcohol, tobacco and illicit drugs. Drug and Alcohol Review, 25, 515–536. doi:10.1080/09595230600944461.CrossRefPubMed

Kendler, K., Prescott, C. A., Myers, J., & Neale, M. C. (2003). The structure of genetic and environmental risk factors for common psychiatric and substance use disorders in men and women. Archive of General Psychiatry, 60, 929–937. doi:10.1001/archpsyc.60.9.929.CrossRef

Kessler, R. C. (2004). The epidemiology of dual diagnosis. Biological Psychiatry, 56, 730–737. doi:10.1016/j.biopsych.2004.06.034.CrossRefPubMed

Kessler, P., Terra, M., Faller, S., Stolf, R., Peuker, C., Benzano, D., & Brazilian ASI Group (2012). Crack users show high rates of antisocial personality disorder, engagement in illegal activities and other psychosocial problems. American Journal on Addictions, 21(4), 370–380. doi:10.1111/j.1521-0391.2012.00245.x.CrossRef

Krueger, R., Hicks, B. M., Patrick, C. J., Carlson, S. R., Iacono, W. G., & McGue, M. (2002). Etiologic connections among substance dependence, antisocial behavior and personality: modeling the externalizing spectrum. Journal of Abnormal Psychology, 122, 1189–1199. doi:10.1037/0021-843X.111.3.411.

Lai, H. M., Cleary, M., Sitharthan, T., & Hunt, G. E. (2015). Prevalence of comorbid substance use, anxiety and mood disorders in epidemiological surveys, 1990–2014: a systematic review and meta-analysis. Drug and Alcohol Dependendence, doi:10.1016/j.drugalcdep.2015.05.031

Langas, A., Malt, U. F., & Opjordsmoen, S. (2012). In-depth study of personality disorders in first-admission patients with substance use disorders. BMC Psychiatry, 12, 180. doi:10.1186/1471-244X-12-180.CrossRefPubMedPubMedCentral

Langbehn, D., Cadoret, R., Caspers, K., Throughton, E. P., & Yucuis, R. (2003). Genetic and environmental risk factors for the onset of drug use and problems in adoptees. Drug & Alcohol Dependence, 69, 151–167. doi:10.1016/S0376-8716(02)00310-1. CrossRef

Levola, J., Aalto, M., Holopainen, A., Cieza, A., & Pitäken, T. (2014). Health-related quality of life in alcohol dependence: a systematic literature review with a specific focus on the role of depression and other psychopathology. Nordic Journal of Psychiatry, 68, 369–3843. doi:10.3109/08039488.2013.852242.CrossRefPubMed

López-Ibor, J., Pérez-Urdániz, A., & Rubio, V. (1996). Examen internacional de los trastornos de la personalidad: modulo DSM-IV. Versión española. Madrid: Organización Mundial de la Salud.

Loranger, A. W., Sartorius, N., Andreoli, A., Berger, P., Buchheim, P., Channabasavanna, S. M., Coid, B., Dahi, A., Diekstra, R. F., & Fergurson, B. (1994). The international personality disorder examination. The World Health Organization/ Alcohol, Drug Abuse and Mental Health Administration international pilot study of personality disorders. Archive of General Psychiatry, 51, 215–224.CrossRef

Magallón-Neri, E. M., Forns, M., Canalda, G., de la Fuente, E., García, R., González, E., Lara, A., & Castro-Fornieles, J. (2013). Usefulness of the international personality disorder examination screening questionnaire for borderline and impulsive personality pathology in adolescent. Comprehensive Psychiatry, 54, 301–308. doi:10.1016/j.comppsych.2012.07.064.CrossRefPubMed

McLellan, A. T. (2002). Have we evaluated addiction treatment correctly? Implications from a chronic care perspective. Addiction, 97, 249–252.CrossRefPubMed

McLellan A.T., Cacciola J. S., Fureman I. (1996). The Addiction Severity Index (ASI) and the Treatment Services Review (TSR). In Sederer L. & Dickey B (Eds.). Outcomes assessment in clinical practice. Williams & Wilkins, Baltimore.

McMahin, R. C., & Enders, C. (2009). Personality disorder factor predict recovery of employment functioning among treated cocaine abusers. American Journal of Drug and Alcohol Abuse, 35(3), 138–144. doi:10.1080/00952990902825397. CrossRef

Meier, P. S., Barrowclough, C., & Donmall, M. C. (2005). The role of the therapeutic alliance in the treatment of substance misuse: a critical review of the literature. Addiction, 100, 304–316.CrossRefPubMed

Miele, G. M., Carpenter, K., Cockerham, M. S., Trautman, K. D., Blaine, J., & Hasin, D. (2000). Substance Dependence Severity Scale (SDSS): reliability and validity of a clinician-administered interview for DSM-IV substance use disorders. Drug & Alcohol Dependence, 59, 63–75. doi:10.1016/S0376-8716(99)00111-8.CrossRef

Moss, H. B., Goldstein, R. B., Chen, C. M., & Hy, Y. (2015). Patterns of use of other drugs among those with alcohol dependence: associations with drinking behavior and psychopathology. Addictive Behaviors, 50, 192–198. doi:10.1016/j.addbeh.2015.06.041.CrossRefPubMedPubMedCentral

Perron, B., Bunger, A., Bender, K., Vaughn, M., & Howard, M. O. (2010). Treatment guideliness for substance use disorders and serious mental illnesses: do they address co-occurring disorders? Substance Use & Misuse, 45(7–8), 1262–1278. doi:10.3109/10826080903442836. CrossRef

Ross, S., Dermatis, H., Levounis, P., & Galanter, M. (2003). A comparison between dually diagnosed inpatients with and without axis II comorbidity and the relationship to treatment outcome. American Journal of Drug and Alcohol Abuse, 29, 263–279. doi:10.1081/ADA-120020511.CrossRefPubMed

Samuels, J. (2011). Personality disorders: epidemiology and public health issues. International Review of Psychiatry, 23, 223–233. doi:10.3109/09540261.2011.588200. CrossRefPubMed

Slade, K., & Forrester, A. (2013). Measuring IPDE-SQ personality disorder prevalence in pre-sentence and early-stage prison populations, with sub-type estimates. International Journal of Law and Psychiatry, 36, 207–212. doi:10.1016/j.ijlp.2013.04.018. CrossRefPubMed

Trull, T. J., Waudby, C. J., & Sher, K. J. (2004). Alcohol, tobacco and drug use disorders and personality disorder symptoms. Experimental and Clinical Psychopharmacology, 12, 65–75. doi:10.1037/1064-1297.12.1.65.CrossRefPubMed

Trull, T. J., Jahn, S., Tomko, R., Wood, P., & Sher, K. (2010). Revised NESARC personality disorder diagnoses: gender, prevalence and comorbidity with substance dependence disorders. Journal of Personality Disorders, 24, 412–426. doi:10.1521/pedi.2010.24.4.412.CrossRefPubMedPubMedCentral

Urbanoski, K., Cairney, J., Adlaf, E., & Rush, B. (2007). Substance abuse and quality of life among severly mentally consumers. A longitudinal modeling analysis. Social Psychiatry and Psychiatric Epidemiology, 42, 810–818.CrossRefPubMed

Vélez-Moreno, A., González-Saiz, F., Rojas, A. J., Torrico, E., Fernández-Calderón, F., Ramírez-López, J., & Lozano, O. M. (2015). Reliability and validity of the Spanish version of the substance dependence severity scale. European Addiction Research, 21, 39–46. doi:10.1159/000365282. CrossRefPubMed

Vergara-Moragues, E., González-Saiz, F., Lozano, O. M., & Verdejo-Garcia, A. (2013). Psychiatric profile of three-month retention in cocaine-dependent patients treated in a therapeutic community. Journal of Studies on Alcohol and Drugs, 74, 452–459.CrossRefPubMed

Verheul, R. & van den Brink, W. (2004). Comorbidity of personality disorders and substance use disorders. In: Kranzler, H.R. and Tinsle, J.A. (Ed.). Dual diagnosis and psychiatric treatment. Substance abuse and comorbid disorders (pp. 261–316). 2° Edition. New-York: Marcel Dekker.

Verheul, R., van den Bosch, L. M. C., & Ball, S. A. (2005). In J. M. Oldham, A. E. Skodol, & D. S. Bender (Eds.), Substance abuse., Textbook of Personality Disorders (pp. 463–476). Washington, DC: The American Psychiatric Publishing Inc..

Westermeyer, J., & Thuras, P. (2005). Association of antisocial personality disorder and substance disorder morbidity in a clinical sample. American Journal of Drug and Alcohol Abuse, 1, 93–110. doi:10.1081/ADA-200047895.CrossRef

Westland, J. C. (2010). Lower bounds on sample size in structural equation modeling. Electronic Commerce Research and Applications, 9(6), 476–487. doi:10.1016/j.elerap.2010.07.003.CrossRef

Worley, M. J., Tate, S. R., Granholm, E., & Brown, S. A. (2014). Mediated and moderated effects of neurocognitive impairment on outcomes of treatment for substance dependence and major depression. Journal of Consulting Clinical Psychology, 82, 418–428. doi:10.1037/a0036033.CrossRefPubMedPubMedCentral

Yen, S., Shea, M. T., Pagano, M., Sanislow, C. A., Grillo, C. M., McGlashan, T. H., Skodol, A. E., Bender, D. S., Zanarini, M. C., Gunderson, J. G., & Morey, L. C. (2003). Axis I and II disorders as predictors of prospective suicide attempts: findings from the Collaborative Longitudinal Personality Disorders Study. Journal of Abnormal Psychology, 113, 375–381.CrossRef

Zimmerman, M., Rothschild, L., & Chelminski, I. (2005). The prevalence of DMS-IV personality disorders in psychiatric outpatients. American Journal of Psychiatry, 162, 911–1918. doi:10.1176/appi.ajp.162.10.1911.

Title: The Impact of Personality Disorders and Severity of Dependence in Psychosocial Problems
Authors: Antonio Vélez-Moreno
Antonio J. Rojas
Francisco Rivera
Fermín Fernández-Calderón
Esperanza Torrico-Linares
Juan Ramírez-López
Francisco González-Saiz
Óscar M. Lozano
Publication date: 01-10-2017
Publisher: Springer US
Published in: International Journal of Mental Health and Addiction / Issue 5/2017
Print ISSN: 1557-1874
Electronic ISSN: 1557-1882
DOI: https://doi.org/10.1007/s11469-016-9696-9

At a glance: The STEP trials

Springer Medicine

The Impact of Personality Disorders and Severity of Dependence in Psychosocial Problems

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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