Christina Hartgers

Prevalence of Personality Disorders among Alcoholics and Drug Addicts: An Overview

Personality disorders (PDs) are considered to be potential predictors of outcome and potential matching variables. In this report the authors review the available epidemiological studies regarding the overall prevalence of DSM-III(Pv) PDs in alcohol, cocaine, opiate and polydrug addicts in both patient and nonpatient samples. Special attention is paid to the prevalence of antisocial and borderline PDs. Fifty-two studies were identified covering the time period 1982–1994. The findings of these studies suggest that the best estimate of overall axis II prevalence ranges from 44% among alcoholics to 79% among opiate addicts. However, a wide range of prevalence rates was observed in all types of substance use disorders. These differences could only partly be accounted for by differences in primary substance of abuse, assessment procedure, and setting. Gender distribution, the alternate application of exclusion criteria, classification system and time-frame, seem to be other important factors in understanding the divergent findings.

Personality disorders predict relapse in alcoholic patients

This prospective study examines the association of DSM-III-R Axis II comorbidity with (time to) relapse since the end of treatment in a sample of 105 outpatient and 82 inpatient alcoholics. Furthermore, this study addresses the role of motivation for change, time in program, and working alliance in the mechanism underlying the association between Axis II and relapse. We found that Axis II comorbidity in alcoholics is a robust predictor of relapse following treatment, while the effect is strongest in outpatients with low motivation for change and/or short time in program. Motivation for change and time in program did not mediate the association of Axis II with relapse. We also found poor working alliance to be related to personality pathology among inpatients, and from our findings it can be hypothesised that poor working alliance is part of the mechanism underlying the observed impact of Axis II on treatment outcome in outpatients. A preliminary model of the role of personality pathology in the mechanism of relapse is proposed.

Antisocial Alcoholic Patients Show as Much Improvement at 14-Month Follow-up as Non-Antisocial Alcoholic Patients

The authors investigated the impact of DSM-III-R adult criteria for antisocial personality disorder (and co-occurrence of childhood conduct or mood disorder) on one-year changes of multi-domain problem severity in 309 alcoholic patients. Adult antisocial traits were associated with more drug, legal, and psychiatric problems at baseline and with more drug problems at follow-up. However, patients with antisocial traits showed at least as much improvement from baseline through follow-up as their non-antisocial counterparts. Furthermore, the co-occurrence of childhood conduct disorder or mood disorder among the antisocial alcoholics did not define prognostically relevant subgroups. These findings suggest that antisocial alcoholics benefit from treatment at least as much as non-antisocial alcoholics.

Sensitivity of the Addiction Severity Index Physical and Sexual Assault Items: Preliminary Findings on Gender Differences

Objective: Evaluation of the Addiction Severity Index (ASI) as a screen for identifying sexual and physical assault histories. Method: The sensitivity and specificity of the ASI assault items were examined in 146 alcoholic patients with the assault questions of the Composite International Diagnostic Interview posttraumatic stress module as external criterion. Results: The sensitivity of the ASI items was lower than their specificity for both physical (sensitivity = 0.35, specificity = 0.83) and sexual abuse (sensitivity = 0.69, specificity = 0.94). These findings indicate an underestimation of such abuse histories in male patients due to screening for a narrow range of possible perpetrators. Conclusion: The ASI method as a screen for sexual and physical assault histories could be improved, considering that men clearly outnumber women in persons applying for alcohol treatment.

Cloninger’s Type I and II Alcoholics amongst Treated Alcoholics: Prevalence and Validity of the Construct

This paper examines the clinical relevance and validity of Cloninger’s type I and type II alcoholism in a sample of 108 residentially treated alcoholics. In terms of prevalence, our findings are probl