Advertisement

Personality Disorder and Addiction

  • Marc WalterEmail author
Chapter

Abstract

Personality disorder and substance use disorder very commonly co-occur. Depending on the sample and setting, comorbid substance use disorder can be diagnosed in approximately every second patient suffering from a personality disorder. Comorbid personality disorder seems to be more prevalent in drug use disorder than in alcohol use disorder. The association between substance use disorder and borderline or antisocial personality disorder is particularly frequent. These comorbidities are generally characterised by severe addiction problems and by an unfavourable clinical course.

The differential indication for the treatment of patients with personality disorder and comorbid substance use disorder is of particular importance. For most patients with personality disorders, psychotherapy is the treatment of choice. Pharmacotherapy is helpful in an acute crisis and for other comorbid psychiatric disorders such as depression and psychosis. Three different evidence-based psychotherapies have been examined for comorbid patients (dialectical behaviour therapy; dynamic deconstructive psychotherapy; dual-focused schema therapy). There have been no controlled trials of pharmacotherapy for patients with personality disorder and substance use disorder.

In conclusion, the principle should generally be applied that the two disorders should be treated together. However, further research is needed to improve the specific treatment options for patients with personality disorder and substance use disorder.

Keywords

Borderline Personality Disorder Personality Disorder Antisocial Personality Disorder Borderline Personality Disorder Borderline Personality Disorder Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Abbott PJ, Weller SB, Walker SR (1994) Psychiatric disorders of opiate addicts entering treatment: preliminary data. J Addict Dis 13:1–11PubMedCrossRefGoogle Scholar
  2. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. (DSM-5). American Psychiatric PublishingGoogle Scholar
  3. Ball SA, Cobb-Richardson P, Connolly AJ, Bujosa CT, O'Neall TW (2005) Substance abuse and personality disorders in homeless drop-in center clients: symptom severity and psychotherapy retention in a randomized clinical trial. Compr Psychiatry 46:371–379PubMedCrossRefGoogle Scholar
  4. Ball SA, Maccarelli LM, LaPaglia DM, Ostrowski MJ (2011) Randomized trial of dual-focused vs. single-focused individual therapy for personality disorders and substance dependence. J Nerv Ment Dis 199:319–328PubMedCentralPubMedCrossRefGoogle Scholar
  5. Blum J, Gerber H, Gerhard U, Schmid O, Petitjean S, Riecher-Rössler A, Wiesbeck GA, Borgwardt SJ, Walter M (2013) Acute effects of heroin on emotions in heroin-dependent patients. Am J Addict 22:598–604PubMedCrossRefGoogle Scholar
  6. Brooner RK, King VL, Kidorf M, Schmidt CW, Bigelow GE (1997) Psychiatric and substance use comorbidity among treatment-seeking opioid abusers. Arch Gen Psychiatry 54:71–80PubMedCrossRefGoogle Scholar
  7. Buckholtz JW, Treadway MT, Cowan RL, Woodward ND, Li R, Ansari MS, Baldwin RM, Schwartzman AN, Shelby ES, Smith CE, Kessler RM, Zald DH (2010) Dopaminergic network differences in human impulsivity. Science 329:532PubMedCentralPubMedCrossRefGoogle Scholar
  8. Clarkin JF, Yeomans FE, Kernberg OF (2006) Psychotherapy of borderline personality disorder. Focusing on object relations. American Psychiatric Publishing, ArlingtonGoogle Scholar
  9. Cohen P, Chen H, Crawford TN, Brook JS, Gordon K (2007) Personality disorders in early adolescence and the development of later substance use disorders in the general population. Drug Alcohol Depend 88(Suppl 1):71–84CrossRefGoogle Scholar
  10. Dammann G, Hügli C, Selinger J, Gremaud-Heitz D, Sollberger D, Wiesbeck GA, Küchenhoff J, Walter M (2011) The self-image in patients with borderline personality disorder. J Pers Disord 25:517–527PubMedCrossRefGoogle Scholar
  11. Dimeff LA, Linehan MM (2008) Dialectical behavior therapy for substance abusers. Addict Sci Clin Pract 4:39–47PubMedCentralPubMedCrossRefGoogle Scholar
  12. Ersche KD, Turton AJ, Chamberlain SR, Müller U, Bullmore ET, Robbins TW (2012) Cognitive dysfunction and anxious-impulsive personality traits are endophenotypes for drug dependence. Am J Psychiatry 169:926–936PubMedCentralPubMedCrossRefGoogle Scholar
  13. Fenton MC, Keyes K, Geier T, Greenstein E, Skodol A, Krueger B, Grant BF, Hasin DS (2012) Psychiatric comorbidity and the persistence of drug use disorders in the United States. Addiction 107:599–609PubMedCentralPubMedCrossRefGoogle Scholar
  14. Galen LW, Brower KJ, Gillespie BW, Zucker RA (2000) Sociopathy, gender, and treatment outcome among outpatient substance abusers. Drug Alcohol Depend 61:23–33PubMedCrossRefGoogle Scholar
  15. Gianoli MO, Jane JS, O’Brien E, Ralevski E (2012) Treatment for comorbid borderline personality disorder and alcohol use disorders: a review of the evidence and future recommendations. Exp Clin Psychopharmacol 20:333–444PubMedCentralPubMedCrossRefGoogle Scholar
  16. Gregory RJ, Chlebowski S, Kang D, Remen AL, Soderberg MG, Stepkovitch J, Virk S (2008) A controlled trial of psychodynamic psychotherapy for co-occurring borderline personality disorder and alcohol use disorder. Psychotherapy (Chic) 45:28–41CrossRefGoogle Scholar
  17. Gregory RJ, DeLucia-Deranja E, Mogle JA (2010) Dynamic deconstructive psychotherapy versus optimized community care for borderline personality disorder co-occurring with alcohol use disorders: a 30-month follow-up. J Nerv Ment Dis 198:292–298PubMedCrossRefGoogle Scholar
  18. Gunderson JG (2011) Borderline personality disorder. N Engl J Med 364:2037–2042PubMedCrossRefGoogle Scholar
  19. Hasin D, Fenton MC, 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. Arch Gen Psychiatry 68:1158–1167PubMedCentralPubMedCrossRefGoogle Scholar
  20. Herpertz SC, Zanarini M, Schulz CS, Siever L, Lieb K, Möller HJ (2007) WFSBP Task Force on Personality Disorders. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of personality disorders. World J Biol Psychiatry 8:212–244PubMedCrossRefGoogle Scholar
  21. Khantzian EJ, Treece C (1985) DSM-III psychiatric diagnosis of narcotic addicts. Recent findings. Arch Gen Psychiatry 150:1067–1071CrossRefGoogle Scholar
  22. Kiefer F, Jahn H, Tarnaske T et al (2003) Comparing and combining naltrexone and acamprosate in relapse prevention of alcoholism: a double-blind, placebo-controlled study. Arch Gen Psychiatry 60:92–99PubMedCrossRefGoogle Scholar
  23. Langås AM, Malt UF, Opjordsmoen S (2012) In-depth study of personality disorders in first-admission patients with substance use disorders. BMC Psychiatry 12:180PubMedCentralPubMedCrossRefGoogle Scholar
  24. Linehan MM (1993) Cognitive-behavioral treatment in borderline personality disorder. Guilford, New YorkGoogle Scholar
  25. Linehan MM, Dimeff LA, Reynolds SK, Comtois KA, Welch SS, Heagerty P, Kivlahan DR (2002) Dialectical behavior therapy versus comprehensive validation therapy plus 12-step for the treatment of opioid dependent women meeting criteria for borderline personality disorder. Drug Alcohol Depend 67:13–26PubMedCrossRefGoogle Scholar
  26. Miller WR, Rollnick S (2002) Motivational interviewing: preparing people for change, 2nd edn. Guilford, New YorkGoogle Scholar
  27. Makris N, Oscar-Berman M, Kim S, Hodge SM, Kennedy DN, Caviness VS, Phil D, Marinkovic K, Breiter HC, Gasic GP, Harris GJ (2008) Decreased volume of the brain reward system in alcoholism. Biol Psychiatry 64:192–202PubMedCentralPubMedCrossRefGoogle Scholar
  28. Marlatt GA, Gordon JR (1985) Relapse prevention: a self-control strategy for the maintenance of behavior change. Guilford, New YorkGoogle Scholar
  29. McGlashan TH, Grilo CM, Skodol AE, Gunderson JG, Shea MT, Morey LC, Zanarini MC, Stout RL (2000) The Collaborative Longitudinal Personality Disorders Study: baseline Axis I/II and II/II diagnostic co-occurrence. Acta Psychiatr Scand 102:256–264PubMedCrossRefGoogle Scholar
  30. Moreno-López L, Catena A, Fernández-Serrano MJ, Delgado-Rico E, Stamatakis EA, Pérez-García M, Verdejo-García A (2012) Trait impulsivity and prefrontal gray matter reductions in cocaine dependent individuals. Drug Alcohol Depend 125:208–214PubMedCrossRefGoogle Scholar
  31. Narayan VM, Narr KL, Kumari V, Woods RP, Thompson PM, Toga AW, Sharma T (2007) Regional cortical thinning in subjects with violent antisocial personality disorder or schizophrenia. Am J Psychiatry 164:1418–1427PubMedCentralPubMedCrossRefGoogle Scholar
  32. Pennay A, Cameron J, Reichert T, Strickland H, Lee NK, Hall K, Lubman DI (2011) A systematic review of interventions for co-occurring substance use disorder and borderline personality disorder. J Subst Abuse Treat 41:363–373PubMedCrossRefGoogle Scholar
  33. Preuss UW, Johann M, Fehr C, Koller G, Wodarz N, Hesselbrock V, Wong WM, Soyka M (2009) Personality disorders in alcohol-dependent individuals: relationship with alcohol dependence severity. Eur Addict Res 15:188–195PubMedCentralPubMedCrossRefGoogle Scholar
  34. Schweizerische Gesellschaft für Suchtmedizin (SSAM, 2006). Medizinische Empfehlungen für substitutionsgestützte Behandlungen (SGB) bei Opioidabhängigkeit. Bern.Google Scholar
  35. Simms GO (1992) ICD-10 Classification of mental and behavioural disorders: Clinical Descriptions and Diagnostic Guidelines. Bertrams.Google Scholar
  36. Strain EC, Brooner RK, Bigelow GE (1991) Clustering of multiple substance use and psychiatric diagnosis in opiate addicts. Drug Alcohol Depend 27:127–134PubMedCrossRefGoogle Scholar
  37. Trull TJ, Jahng S, Tomko RL, Wood PK, Sher KJ (2010) Revised NESARC personality disorder diagnoses: gender, prevalence, and comorbidity with substance dependence disorders. J Pers Disord 24:412–426PubMedCentralPubMedCrossRefGoogle Scholar
  38. Verheul R, Kranzler HR, Poling J, Tennen H, Ball S, Rounsaville BJ (2000) Axis I and Axis II disorders in alcoholics and drug addicts: fact or artifact? J Stud Alcohol 61:101–110PubMedGoogle Scholar
  39. Verheul R (2001) Co-morbidity of personality disorders in individuals with substance use disorders. Eur Psychiatry 16:274–282PubMedCrossRefGoogle Scholar
  40. Verheul R, Van Den Bosch LM, Koeter MW, De Ridder MA, Stijnen T, Van Den Brink W (2003) Dialectical behaviour therapy for women with borderline personality disorder: 12-month, randomised clinical trial in The Netherlands. Br J Psychiatry 182:135–140PubMedCrossRefGoogle Scholar
  41. van den Bosch LM, Verheul R, Schippers GM, van den Brink W (2002) Dialectical behavior therapy of borderline patients with and without substance use problems. Implementation and long-term effects. Addict Behav 27:911–923PubMedCrossRefGoogle Scholar
  42. Walter M, Gunderson JG, Zanarini MC, Sanislow C, Grilo CM, McGlashan TH, Morey LC, Yen S, Stout R, Skodol A (2009) New onsets of substance use disorders in borderline personality disorder over seven years of follow-ups. Addiction 204:97–103CrossRefGoogle Scholar
  43. Walter M, Wiesbeck GA, Dittmann V, Graf M (2011) Criminal recidivism in offenders with personality disorders and substance use disorders over 8 years of time at risk. Psychiatry Res 186:443–445PubMedCrossRefGoogle Scholar
  44. Young JE (1994) Cognitive therapy for personality disorders: a schema-focused approach. Professional Resource Exchange Inc., SarasotaGoogle Scholar
  45. Zanarini MC, Frankenburg FR, Hennen J, Reich DB, Silk KR (2004) Axis I comorbidity in patients with borderline personality disorder: 6-year follow-up and prediction of time to remission. Am J Psychiatry 161:2108–2114PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  1. 1.Department of Psychiatry (UPK)University of BaselBaselSwitzerland

Personalised recommendations