Scholarly article on topic 'The incidence of personality disorders among substance dependents and non-addicted psychiatric clients'

The incidence of personality disorders among substance dependents and non-addicted psychiatric clients Academic research paper on "Clinical medicine"

CC BY-NC-ND
0
0
Share paper
OECD Field of science
Keywords
{"Personality disorders / anti-social personality disorders / borderline pd personality disorders / substance abuse"}

Abstract of research paper on Clinical medicine, author of scientific article — Majid Darvishi Zadeh, Alireza Jilardi Damavandi

Abstract Resistance against treatment, severity of symptoms and relapse to substance addiction can be resulted from low attention and sometimes inattention to existence of personality disorders in substance dependent individuals in rehabilitation clinics. In order to study and compare the incidence of personality disorders in substance dependents and non-addicted psychiatric clients, Millon Clinical Multiaxial Inventory (MCMI) II was administered on 75 substance dependent males and 75 non-addicted psychiatric male clients. Age, gender, education level were controlled in both group of Clients. Findings show that the rate of personality disorder prevalence in substance dependent individuals was 45.3% in compare with 25.3% for the non addicted clients. Results of t-tests analyses indicate that the prevalence rate of personality disorders (specifically, borderline and anti-social personality disorders) in substance dependent individuals is significantly higher than this ratio in non-addicted psychiatric clients. Meanwhile, there was no significant difference between the two groups in narcissistic personality disorder. In conclusion, this study highlighted the importance of paying attention to personality disorders and their related treatments along with other approaches in treatment process of substance dependent individuals. Other implications are discussed.

Academic research paper on topic "The incidence of personality disorders among substance dependents and non-addicted psychiatric clients"

Available online at www.sciencedirect.com

ScienceDirect

Procedía Social and Behavioral Sciences 5 (2010) 781-784

WCPCG-2010

The incidence of personality disorders among substance dependents

and non-addicted psychiatric clients

Majid Darvishi Zadeha, Alireza Jilardi Damavandia *

aUniversiti Putra Malaysia, Serdang, 43400, Selangor,Malaysia Received January 4, 2010; revised January 20, 2010; accepted March 17, 2010

Abstract

Resistance against treatment, severity of symptoms and relapse to substance addiction can be resulted from low attention and sometimes inattention to existence of personality disorders in substance dependent individuals in rehabilitation clinics. In order to study and compare the incidence of personality disorders in substance dependents and non-addicted psychiatric clients, Millon Clinical Multiaxial Inventory (MCMI) II was administered on 75 substance dependent males and 75 non-addicted psychiatric male clients. Age, gender, education level were controlled in both group of Clients.

Findings show that the rate of personality disorder prevalence in substance dependent individuals was 45.3% in compare with 25.3% for the non addicted clients. Results of t-tests analyses indicate that the prevalence rate of personality disorders (specifically, borderline and anti-social personality disorders) in substance dependent individuals is significantly higher than this ratio in non-addicted psychiatric clients. Meanwhile, there was no significant difference between the two groups in narcissistic personality disorder. In conclusion, this study highlighted the importance of paying attention to personality disorders and their related treatments along with other approaches in treatment process of substance dependent individuals. Other implications are discussed.

© 2010 Elsevier Ltd. All rights reserved.

Keywords, Personality disorders, anti-social personality disorders, borderline pd personality disorders, substance abuse.

1. Introduction

Personality disorders have been identified as one of the most important predictors of treatment outcome in patients having substance use disorders (Rounsaville, Kosten, Weissman and Kleber, 1986; Carroll, Power, Bryant and Rounsaville, 1993; Compton, Cottler, Jacobs, Ben-Abdallah and Spitznagel, 2003; Haro, Mateu, Martínez-Raga, Valderrama, Castellano and Cervera, 2004). Especially, the cluster B personality disorders are the most prevalent (Antisocial, Borderline, and less often Narcissistic and Histrionic); meanwhile, both cluster C (Avoidant and Dependent and less often Obsessive-Compulsive) and cluster A (Paranoid and less often Schizoid and Schizotypal) disorders are also common in substance abusers (Ball, 2004). In this regard, specific personality disorders such as the antisocial personality disorders have consistently been reported as the most prevalent co-morbid psychiatric diagnoses in alcohol or drug dependent individuals (Verheul, 2001).

* Alireza Jilardi Damavandi, Tel.: +60-17-3370522. E-mail address: alireza_jilardy@yahoo.com.

1877-0428 © 2010 Published by Elsevier Ltd. doi:10.1016/j.sbspro.2010.07.184

Although there have been many studies conducted on the relationship between PDs and SUD, in order to check severity of PDs in substance user, this study aimed to investigate the incidence of personality disorders in substance dependents and non-addicted psychiatric clients. Meanwhile, it is crucial to get a better understanding of the complex relationship of personality disorders and substance use disorders for a better planning of more efficacious treatment and prevention strategies (Haro, Mateu, Martínez-Raga, Valderrama, Castellano and Cervera, 2004). Therefore the following hypotheses is addressed, 1) there is no significant difference in prevalence of personality disorders between substance dependents and non-addicted psychiatric clients. 2) there is no significant difference in prevalence of Antisocial PD between substance dependents and non-addicted psychiatric clients. 3) there is no significant difference in prevalence of Borderline PD between substance dependents and non-addicted psychiatric clients. 4) there is no significant difference in prevalence of Narcissistic PD between substance dependents and non-addicted psychiatric clients.

2. Respondents

Data were collected from a sample of 75 patients with a diagnosis of substance abuse or dependence, who referred to detoxification and rehabilitation center in Kermanshah, Iran; in addition to 75 psychiatric clients who were admitted based on DSM.IV criteria in Axis I. respondents were all male between 18 to 45 years old and they have at least eight years of education.

3. Instrument

The Millon Clinical Multiaxial Inventory (1987) is the revision of the first edition of the MCMI and was developed to complement the DSM-III-R (American Psychiatric Association, 1987). MCMI consists of 175 true-false items anchored on Millon's theory of personality and psychopathology. The inventory provides ratings of 10 basic personality patterns and three more severe pathological personality styles. It also has nine scales assessing clinical symptoms, and three scales are validity indices. The applied inventory (MCMI-II) provides both continuous scores for each of the PDs as well as base-rate scores (BR scores), which are designed to measure the presence or absence of a particular PD. Base-rate scores of 85 or higher are used as indices for the presence of a personality disorder. As Marlowe, Festinger, Kirby, Rubinstein and Platt (1998) have established, the congruence of the MCMIII and the MCMI-III, validated for the DSM-IV (American Psychiatric Association, 1994) is acceptable. In this study the reliability coefficients were satisfactory and the reliability for the narcissistic and the antisocial PDs are among the highest.

4. Findings

Outcomes of (MCMI) II on 75 substance dependent males and 75 non-addicted psychiatric male clients were entered in independent T test analysis to compare personality disorders in the two groups. Age, gender, education level were controlled in both group of Clients. The first hypothesis suggests that there is no significant difference in prevalence of personality disorders between substance dependents and non-addicted psychiatric clients. Results of T test for independent groups are given in table 1.

Table 1, t-test for Equality of personality disorder Means in two groups

Mean Difference Std. Error Difference Confidence Interval of the

Personality disorders t df Difference 95% 99%

Equal variance assumed 2.735 148 10.106 3.69 1.64 1.96

As indicated in table 1, comparing group means, our main hypothesis that the drug dependent individuals would show higher rate of personality disorders than non-addicted psychiatric clients was presently confirmed. Further investigations show that among personality disorders, prevalence of Anti-social and Borderline personality disorders is different in substance dependents and non-addicted psychiatric clients. Moreover, comparing means, it was found

that the prevalence in substance dependent males is higher than non-addicted psychiatric clients. Results of two T-test analyses are presented in table 2 and table 3. However, there was no significant difference in prevalence of Narcissistic PD between substance dependents and non-addicted psychiatric clients.

Table 2, t-test for Equality of Anti-social personality disorder Means in two groups

Std. Confidence Interval of the

Anti-social PD t d Mean Error Difference

f Difference Differenc e 95% 99%

Equal variance assumed 2.77 1 4 8 11.38 4.1 1.64 1.96

Table 3, t-test for Equality of Borderline personality disorder Means in two groups

Std. Confidence Interval of the

Borderline PD t df Mean Error Difference

Difference Differen ce 95% 99%

Equal variance assumed 2 3 263 148 9. 5 4 1.64 1.96

5. Discussion

In order to study and compare the incidence of personality disorders in substance dependents and non-addicted psychiatric clients, Millon Clinical Multiaxial Inventory (MCMI) II was administered on 75 substance dependent males and 75 non-addicted psychiatric male clients. Findings show that the prevalence rate of personality disorders (specifically, borderline and anti-social personality disorders) in substance dependent individuals is significantly higher than this ratio in non-addicted psychiatric clients.

Substance abuse and its co-occurrence with personality disorders is associated with higher substance abuse and psychiatric symptom severity (Brooner, King, Kidorf, Schmidt, & Bigelow, 1997; Rounsaville, Kranzler, H. R., Ball, S., Tennen, H., Poling, J., & TriZeman, 1998) and increased risk for suicide, hospitalization, repeated treatment admissions, over-utilization of medical care, employment and legal problems, victimization or perpetration of abuse, and HIV infection (Target, 1998). Personality disorder presence appears to render substance abusers more susceptible to relapse in the presence of craving, negative physical and emotional states, and interpersonal conflict (Kruedelbach, McCormick, Schulz, & Grueneich, 1993; Smyth & Washousky, 1995) and worse outcome when provided routine or less intensive addiction treatment (Griggs & Tyrer, 1981; Nace & Davis, 1993; Thomas, Melchert, & Banken, 1999). However, antisocial and borderline personality disordered patients appear to benefit at least as much as other patients when provided addiction treatment enhanced with psychiatric care, psychosocial services, potent behavioral incentive contingencies, or cognitive-behavioral therapies (Brooner, Kidorf, King, & Stoller, 1998; Cacciola, Rutherford, Alterman, McKay, & Snider, 1996; Kadden, Cooney, Getter, & Litt, 1989). This study highlighted the importance of paying attention to personality disorders and their related treatments along with other approaches in treatment process of substance dependent individuals.

This study has several limitations; first, there might be an unmeasured third variable that is related to both PDs and SUDs. As we know, age is associated with both PDs and SUDs, and higher rates of comorbidity may be found in younger samples than in the general population. Although, age was controlled in this study; other variables can influence the results, such as childhood trauma (especially physical and sexual abuse) which has been associated with both adult SUDs (Brown & Anderson, 1991) and PDs (Sabo, 1997). Another crucial class of comorbidity explanations to consider is that SUDs cause or lead to PD (or vice versa). In other words, one condition may be the consequence of the other. On the other hand, individuals with BPD might turn to psychoactive substances in order to "self-medicate" affective disturbance or to cope with feelings of emptiness or abandonment (e.g., Dulit, Fyer, Haas, Sullivan, and Frances, 1990); in this case, PDs might influence the development of SUD. Second, the current study

rely on a self-report questionnaire to assess personality functioning. Self-report measures of PDs over-report the presence and severity of PDs. Finally, this study is cross-sectional and is conducted on patients who are either currently in or recently ending an active phase of their SUD. Therefore, generalization of findings should be made cautiously.

References

American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed. rev.). Washington, DC: American Psychiatric Press.

American Psychiatric Association (1994). Diagnostic and statistical manual of mentaldisorders (4th ed.). Washington, DC: Author.

Ball, S. A. (2005). Personality traits, problems, and disorders: Clinical applications to substance use disorders, Journal of Research in Personality, 39, 84-102

Brooner, R. K., Kidorf, M., King, V. L., & Stoller, K. (1998). Preliminary evidence of good treatment response in antisocial drug abusers. Drug and Alcohol Dependence, 49, 249-260.

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

Brown, G. R., & Anderson, B. (1991). Psychiatric morbidity in adult inpatients with childhood histories of sexual and physical abuse. American Journal of Psychiatry, 148, 55-61.

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

Carroll KM, Power M-ED, Bryant K, Rounsaville BJ. One-year follow-up status of treatment-seeking cocaine abusers. Psychopathology and dependence severity as predictors of outcome. J Nerv Ment Dis 1993;181:71-9.

Compton III WM, Cottler LB, Jacobs JL, Ben-Abdallah A, Spitznagel EL. The role of psychiatric disorder in predicting drug dependence treatment outcomes. Am J Psychiatry 2003;160:890-5.

Dulit, M. Fyer, G. Haas, T. Sullivan and A. Frances, Substance use in borderline personality disorder. Am J Psychiatry (1990), pp. 1002-1007.

Griggs, S. M., & Tyrer, P. J. (1981). Personality disorder, social adjustment and treatment outcome in alcoholics. Journal of Studies on Alcohol, 42,802-805.

Haro, G., Mateu, C., Marinez-Raga, J., Valderrama, J. C., Castellano, M., & Cervera, C. (2004). The role of personality disorders on drug dependence treatment outcomes following detoxification. European Psychiatry, 19(4), 187-192.

Kadden, R. M., Cooney, N. L., Getter, H., & Litt, M. D. (1989). Matching alcoholics to coping skills or interactional therapies: Posttreatment results. Journal of Consulting and Clinical Psychology, 57, 698- 704.

Kruedelbach, N., McCormick, R. A., Schulz, S. C., & Grueneich, R. (1993). Impulsivity, coping styles, and triggers for craving in substance abusers with borderline personality disorder. Journal of Personality Disorders, 7, 214-222.

Marlowe, D. B., Festinger, D. S., Kirby, D. C., Rubinstein, D. F., & Platt, J. J. (1998). Congruence of the MCMI-II and MCMI-III in cocaine dependence. Journal of Personality Assessment, 71, 15- 28.

Millon, T. (1987). Manual for the MCMI-II. Minneapolis, MN: National Computer Systems.

Nace, E. P., & Davis, C. W. (1993). Treatment outcome in substance abusing patients with a personality disorder. American Journal of Addictions, 2, 26-33.

Rounsaville BJ, Kosten T, Weissman MM, Kleber HD. Prognostic significance of psychopathology in treated opiate addicts. Arch Gen Psychiatry 1986;43:739-45 A 2.5 year follow-up study.

Rounsaville, B. J., Kranzler, H. R., Ball, S., Tennen, H., Poling, J., & TriZeman, E. (1998). Personality disorders in substance abusers: Relation to substance use. Journal of Nervous and Mental Disease, 186, 87-95.

Sabo, A. N. (1997). Etiological significance of associations between childhood trauma and borderline personality disorder: Conceptual and clinical implications. Journal of Personality Disorders, 11, 50-70.

Smyth, N. J., & Washousky, R. C. (1995). The coping styles of alcoholics with Axis II disorders. Journal of Substance Abuse, 7, 425-435.

Target, M. (1998). Outcome research on the psychosocial treatment of personality disorders. Bulletin of the Meninger Clinic, 62, 215-230.

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

Verheul, R. Co-morbidity of personality disorders in individuals with substance use disorders. Eur Psychiatry 2001;16:274-82.