Skip to main content
Log in

Substance use disorder and personality disorder

Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Personality disorders (PDs) and substance use disorders (SUDs) frequently co-occur in both the general population and in clinical settings. Literature is reviewed documenting high comorbidity between these two classes of disorders, possible mechanisms of comorbidity, and the clinical implications of this comorbidity. Special emphasis is given to antisocial personality disorder (ASPD) and borderline personality disorder (BPD) as these disorders not only co-occur frequently with SUDs in the clinical populations and present clinical challenges, but also because recent research points to etiologic processes that are common to these specific PDs and SUDs. Although most attention on comorbidity between PDs and SUDs has focused on ASPD and BPD, it is also clear that other PDs (in particular, avoidant PD and paranoid PD) are prevalent among those suffering from SUDs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References and Recommended Reading

  1. Helzer JE, Canino GJ: Comparative analysis of alcoholism in ten cultural regions. In Alcoholism in North America, Europe, and Asia. New York: Oxford University Press; 1992:289–308.

    Google Scholar 

  2. Kessler RC, McGonagle KA, Zhao S, et al.: Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: Results from the National Comorbidity Survey. Arch Gen Psychiatry 1994, 51:8–19.

    PubMed  CAS  Google Scholar 

  3. American Psychiatric Association: Diagnostic and statistical manual of mental disorders, edn 4. Washington, DC: American Psychiatric Association Press; 1994.

    Google Scholar 

  4. Sher KJ, Trull TJ, Bartholow BD, Vieth A: Personality and alcoholism: issues, methods, and etiological processes. In Psychological Theories of Drinking and Alcoholism. Edited by Leonard KE, Blane HT. New York: Guilford; 1999:54–105. An important article.

    Google Scholar 

  5. Torgersen S, Kringlen E, Cramer V: The prevalence of personality disorders in a community sample. Arch Gen Psychiatry 2001, 58:590–596. A good review.

    Article  PubMed  CAS  Google Scholar 

  6. Thomas V, Melchert TP, Banken JA: Substance dependence and personality disorders: comorbidity and treatment outcome in an inpatient population. J Stud Alcohol 1999, 60:271–277.

    PubMed  CAS  Google Scholar 

  7. Wolwer W, Burtscheidt W, Redner C, et al.: Out-patient behaviour therapy in alcoholism: impact of personality disorders and cognitive impairments. Acta Psychiatrica Scandinavica 2001, 103:30–37.

    Article  PubMed  CAS  Google Scholar 

  8. Dulit RA, Fyer MR, Haas GL, et al.: Substance use in borderline personality disorder. Am J Psychiatry 1990, 147:1002–1007.

    PubMed  CAS  Google Scholar 

  9. Ballenger JC, Goodwin FK, Major LF, Brown GL: Alcohol and central serotonin metabolism in men. Arch Gen Psychiatry 1979, 36:224–227.

    PubMed  CAS  Google Scholar 

  10. Links PS, Heslegrave RJ, Mitton JE, et al.: Borderline psychopathology and recurrences of clinical disorders. J Nerv Ment Dis 1995, 183:582–586.

    Article  PubMed  CAS  Google Scholar 

  11. Kruedelbach N, McCormick RA, Schulz SC, Grueneich R: Impulsivity, coping styles, and triggers for craving in substance abusers with borderline personality disorder. J Personal Dis 1993, 7:214–222.

    Google Scholar 

  12. Ruegg R, Frances A: New research in personality disorders. J Personal Dis 1995, 9:1–48.

    Google Scholar 

  13. Grande TP, Wolf AW, Schubert DS, et al.: Associations among alcoholism, drug abuse, and antisocial personality: a review of literature. Psychol Rep 1984, 55:455–474.

    PubMed  CAS  Google Scholar 

  14. Lewis CE: Alcoholism, antisocial personality, narcotic addition: an integrative approach. Psychiatr Dev 1984, 3:223–235.

    CAS  Google Scholar 

  15. Grilo CM, Martino S, Walker ML, et al.: Controlled study of psychiatric comorbidity in psychiatrically hospitalized young adults with substance use disorders. Am J Psychiatry 1997, 154:1305–1307.

    PubMed  CAS  Google Scholar 

  16. Trull TJ, Sher KJ, Minks-Brown C, et al.: Borderline personality disorder and substance use disorders: a review and integration. Clin Psychol Rev 2000, 20:235–253.

    Article  PubMed  CAS  Google Scholar 

  17. Verheul R, Kranzler HR, Poling J, et al.: Axis I and axis II disorders in alcoholics and drug addicts: fact or artifact? J Stud Alcohol 2000, 61:101–109.

    PubMed  CAS  Google Scholar 

  18. Ball SA, Rounsaville BJ: Reliability of personality disorder symptoms and personality traits in substance-dependent inpatients. J Abnorm Psychol 2001, 110:341–352.

    Article  PubMed  CAS  Google Scholar 

  19. Regier DA, Narrow WE, Rae DS: The epidemiology of anxiety disorders: the Epidemiologic Catchment Area (ECA) experience. J Psychiatr Res 1990, 24:3–14.

    Article  PubMed  Google Scholar 

  20. Kessler RC, Crum RM, Warner LA, et al.: Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey. Arch Gen Psychiatry 1997, 54:313–321.

    PubMed  CAS  Google Scholar 

  21. Stoff DM, Breiling J, Jager JD: Textbook of Antisocial Behavior. New York: Wiley; 1997.

    Google Scholar 

  22. Trull TJ, Widiger TA: Personality disorders. In Comprehensive Handbook of Psychology, vol 8. Edited by Stricker G Widiger TA. Washington, DC: American Psychological Association; In press.

  23. Cloninger CA: Neurogenetic adaptive mechanisms in alcoholism. Science 1987, 236:410–416.

    Article  PubMed  CAS  Google Scholar 

  24. Cloninger CA: A systematic method for clinical description and classification of personality variants. Arch Gen Psychiatry 1987, 44:573–588.

    PubMed  CAS  Google Scholar 

  25. Alterman AI, Bedrick J, Cacciola JS, et al.: Personality pathology and drinking in young men at high and low familial risk for alcoholism. J Stud Alcohol 1998, 59:495–502.

    PubMed  CAS  Google Scholar 

  26. Slutske WS, Heath AC, Dinwiddie SH, et al.: Common genetic risk factors for conduct disorder and alcohol dependence. J Abnorm Psychol 1998, 107:363–374.

    Article  PubMed  CAS  Google Scholar 

  27. Jang KL, Vernon PA, Livesley WJ: Personality disorder traits, family environment, and alcohol misuse: a multivariate behavioral genetic analysis. Addiction 2001, 95:873–888.

    Article  Google Scholar 

  28. Grant BF, Dawson DA: Age at onset of alcohol use and its association with DSM-IV alcohol abuse and dependence: Results from the National longitudinal alcohol epidemiologic survey. J Subst Abuse 1997, 9:103–110.

    Article  PubMed  CAS  Google Scholar 

  29. McGue M, Iacono G, Legrand LN, et al.: Origins and consequences of age at first drink, I. Associations with substance-use disorders, disinhibitry behavior and psychopathology, and P3 amplitude. Alcohol Clin Exp Res 2001, 25:1156–1165. A good review.

    Article  PubMed  CAS  Google Scholar 

  30. DeWit DJ, Adlaf EM, Offord DR, Ogborne AC: Age at first alcohol use: A risk factor for the development of alcohol disorders. Am J Psychiatry 2000, 157:745–750.

    Article  PubMed  CAS  Google Scholar 

  31. Prescott CA, Kendler KS: Age at first drink and risk for alcoholism: a noncausal association. Alcohol Clin Exp Res 1999, 23:101–107.

    PubMed  CAS  Google Scholar 

  32. Costello EJ, Erkanli A, Federman E, Angold A: Development of psychiatric comorbidity with substance abuse in adolescents: effects of timing and sex. J Clin Child Psychology 1999, 28:298–311.

    Article  CAS  Google Scholar 

  33. Krueger RF: The structure of common mental disorders. Arch Gen Psychiatry 1999, 56:921–926.

    Article  PubMed  CAS  Google Scholar 

  34. Sutker PB, Allain AN Jr: Antisocial personality disorder. In Comprehensive Handbook of Psychopathology, edn 3. Edited by Sutker PB, Adams HE. New York: Kluwer Academic/Plenum; 2001:445–490.

    Google Scholar 

  35. Smith SS, Newman JP: Alcohol and drug abuse-dependence disorders in psychopathic and nonpsychopathic criminal offenders. J Abnorm Psychol 1990, 99:430–439.

    Article  PubMed  CAS  Google Scholar 

  36. Yoshino A, Fukuhara T, Kato M: Premorbid risk factors alcohol alcohol dependence in antisocial personality disorder. Alcohol Clin Exp Res 2000, 24:35–38.

    Article  PubMed  CAS  Google Scholar 

  37. Babor TF: The classification of alcoholics: typology theories from the 19th century to the present. Alcohol Health Res World 1996, 20:6–17.

    Google Scholar 

  38. Murray MG, Anthenelli RM, Maxwell RA: Use of health services by men with and without antisocial personality disorder who are alcohol dependent. Psychiatr Serv 2000, 51:380–382.

    Article  PubMed  CAS  Google Scholar 

  39. Longabaugh R, Rubin A, Malloy P, et al.: Drinking outcomes of alcohol abusers diagnosed as antisocial personality disorder. Alcohol Clin Exp Res 1994, 18:778–785.

    Article  PubMed  CAS  Google Scholar 

  40. Project Match Research Group: Matching alcoholism treatments to client heterogeneity: project MATCH postreatment drinking outcomes. J Stud Alcohol 1997, 58:7–29.

    Google Scholar 

  41. Widiger TA, Trull TJ: Borderline and narcissistic personality disorders. In Comprehensive handbook of psychopathology, edn 2. Edited by Adams H, Sutker P. New York: Plenum; 1993:371–394.

    Google Scholar 

  42. Gunderson JG, Zanarini M: Current overview of the borderline diagnosis. J Clin Psychiatry 1987, 48(suppl):5–11.

    PubMed  Google Scholar 

  43. Swartz MS, Blazer DG, George LK, Winfield I: Estimating the prevalence of borderline personality disorder in the community. J Personal Disord 1990, 4:257–272.

    Google Scholar 

  44. Zimmerman M, Coryell W: DSM-III personality disorder diagnoses in a nonpatient sample: demographic correlates and comorbidity. Arch Gen Psychiatry 1989, 46:682–689.

    PubMed  CAS  Google Scholar 

  45. Gunderson JG: Borderline Personality Disorder: A Clinical Guide. Washington, DC: American Psychiatric Press; 2001.

    Google Scholar 

  46. Kernberg O: Severe Personality Disorders. New Haven, CT: Yale University Press; 1984.

    Google Scholar 

  47. Millon T: Disorders of Personality: DSM-III Axis II. New York: Wiley Press; 1981.

    Google Scholar 

  48. Zanarini MC, Frankenburg FR: Pathways to the development of borderline personality disorder. J Personal Dis 1997, 11:93–104.

    CAS  Google Scholar 

  49. Morgenstern J, Langenbucher J, Labouvie E, Miller KJ: The comorbidity of alcoholism and personality disorders in a clinical population: Prevalence rates and relation to alcohol typology variables. J Abnorm Psychol 1997, 106:74–84.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sher, K.J., Trull, T.J. Substance use disorder and personality disorder. Curr Psychiatry Rep 4, 25–29 (2002). https://doi.org/10.1007/s11920-002-0008-7

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11920-002-0008-7

Keywords

Navigation