Dual Diagnosis: Alcoholism and Co‐Morbid Psychiatric Disorders

Kranzler, Henry R.; Rosenthal, Richard N.

doi:10.1111/j.1521-0391.2003.tb00494.x

Cited by 67 publications

(44 citation statements)

References 74 publications

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“…Instead, A+PD showed more extensive abuse of medicine/drugs, especially A+PDB. This has also been found in other studies, where these patients had a greater prevalence of drug and alcohol abuse [7,18,19] . However, it should be emphasized that very few of our patients had a drug abuse problem, and it was always abuse of either benzodiazepines or cannabis.…”

Section: Discussionsupporting

confidence: 85%

“…The young age of A+PDB may have been due to the early onset of the alcohol abuse, so that at the time of the interview they had been abusing alcohol for longer than the rest of the patients. In other studies, dissocial alcoholics were found to have an earlier onset of alcohol use [19,22] . Young age, being male and having serious problems combined with alcohol abuse also correlates with Cloninger's type 2 and Babor's type B alcoholics, and a new study has reported that type B includes significantly more PDB [22] .…”

Section: Discussionmentioning

confidence: 72%

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Personality Disorders among Danish Alcoholics Attending Outpatient Treatment

Nordholm

Nielsen

2007

Eur Addict Res

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The aim of the present study was firstly to describe the characteristics of alcoholic outpatients (A) suffering from co-morbid personality disorder (PD) of either the cluster B (A+PDB) or cluster C (A+PDC) type. Secondly, to investigate the effect of various kinds of treatment to be able to single out the most beneficial therapy. Thirdly, to identify the most beneficial treatment. The patients were offered the following outpatient treatments: cognitive behaviour therapy, family therapy and supportive consultations. The material consisted of 363 patients who started psychosocial treatment at the outpatient alcohol clinic at Odense University Hospital, Denmark. It was possible to re-interview 276 (76%) patients 1 year after onset of treatment. Of the 363 patients, 87% were alcohol-dependent (ICD-10) and 34% fulfilled the ICD-10-R criteria for PDs. The basic interviews focused on the seven main areas of the Addiction Severity Index. A+PDC had significantly more serious medical problems than A–PD, while the A+PDB group had significantly more employment, drug use and social problems than the A–PD. As for psychiatric status, A–PD had significantly different scores compared with A+PDB and A+PDC. A+PDB were younger and had a longer history of alcohol abuse than A–PD and A+PDC. After treatment there was no significance between the patients with and without PD concerning alcohol outcome and psychosocial outcome. The significance of co-morbid PD for the prognosis of alcohol abusers may be overestimated. Our results indicate that A+PD can be treated as successfully as other patients in an outpatient alcohol clinic can.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 72%

Personality Disorders among Danish Alcoholics Attending Outpatient Treatment

Nordholm

Nielsen

2007

Eur Addict Res

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“…However, Cluster B PDs appear to be particularly prevalent among alcoholics, 2,3,[5][6][7]10,11,13 with both ASPD and BPD overrepresented in this population. 1,6,8,11,[21][22][23][24] In turn, alcohol use disorders are highly prevalent among people with Cluster B PDs. In the NESARC, alcohol use disorders were more frequently encountered among the 2 Cluster B PDs studied (in 28.7 % of people with ASPD and in 29.1% of those with histrionic PD) than those with other types of PDs.…”

mentioning

confidence: 99%

Personality Disorders among Alcoholic Outpatients: Prevalence and Course in Treatment

2010

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Objective: To determine the prevalence of concurrent personality disorders (PDs) among alcoholic men and women seeking outpatient treatment, and to examine their effect on the course of alcohol treatment. Method:Patients with alcohol use disorders (n = 165) were assessed by clinical and semi-structured interviews, as well as self-report scales, to measure levels of psychological distress, impulsivity, social functioning, and addiction severity at treatment intake. PD diagnoses were assessed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Personality Disorder (SCID-II). Course in treatment was monitored prospectively for 12 weeks. Results:Using the results of the SCID-II (n = 138), the sample was divided into 3 groups-that is, no PD 41% (n = 57), Cluster B PD 32% (n = 44), and other PD 27% (n = 37). The 3 groups did not differ in their alcohol use severity at intake. However, the Cluster B PD group achieved alcohol milestones at a younger age. Subjects with a PD had more severe psychological and social problems at intake. The Cluster B PD group showed significantly higher levels of impulsivity at intake, greater likelihood of early treatment dropout, and quicker times to first slip and to relapse. Conclusions:This study supports the high prevalence of concurrent PDs, particularly Cluster B PDs, among treatment-seeking alcoholics. The relation between observed high levels of impulsivity and worse course in early alcohol treatment among people with a Cluster B PD merits further investigation.Can J Psychiatry. 2010;55(2):65-73. Clinical Implications· Among our outpatient treatment-seeking alcoholic sample, 59% had a PD, underscoring the importance of screening for this comorbidity. · Cluster B PDs were especially prevalent in our sample population (32%) and showed significantly higher levels of impulsivity at intake. · Subjects with Cluster B PD showed significantly poorer course in early alcohol treatment, confirming the clinical experience of difficulty engaging this population into treatment. Limitations· Our findings are not generalizable to alcohol use disorders as a whole, given that subjects were treatment-seeking outpatients with no comorbid drug dependence. · We were unable to examine outcomes for 20% of our sample owing to attrition, refusal to attend follow-up interviews, or missing data. · The current sample size limits our ability to further examine the complex relation between Cluster B PD and impulsivity, and their impact on alcoholism.

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“…alcohol and other psychoactive substances are also associated with a higher incidence of depression and a higher risk of suicide, although the association between depression and alcohol addiction is not as strong as in bipolar affective disorder [30][31][32]. in Poland, 10.9% of subjects abuse alcohol, including 18.6% of men.…”

Section: Medical Historymentioning

confidence: 99%