Personality disorders predict relapse in alcoholic patients

Verheul, Roel; Brink, Wim van den; Hartgers, C.

doi:10.1016/s0306-4603(98)00065-3

Cited by 97 publications

(68 citation statements)

References 29 publications

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“…Moreover, it has been shown that treatment attendance in alcoholics is favourably related to outcome and that great importance should be paid to client retention in programs to derive benefit from therapy. 12,45 The observation that Cluster B PDs are overrepresented in alcoholics, compared both with the general population 17,46,47 and with psychiatric patients, 20 where Cluster C PDs prevail, raises the question of an underlying shared biological or environmental denominator. One predisposing factor that has been consistently linked to substance abuse is impulsivity.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

confidence: 99%

Personality Disorders among Alcoholic Outpatients: Prevalence and Course in Treatment

2010

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“…Several studies have found that affective, anxiety, and antisocial personality disorders are associated with a high risk of relapse to heavy drinking (Driessen et al, 2001;Galen et al, 2000;Greenfield et al, 1998;Kranzler et al, 1996;Strowig, 2000;Verheul et al, 1998;Willinger et al, 2002). In addition to psychiatric diagnoses, severity of psychopathology also has been found to be more pronounced among patients who had relapsed to alcohol and/or drug use compared with abstainers (Curran et al, 2000;Hasin et al, 2002;McLellan et al, 1983;Snow and Anderson, 2000).…”

Section: Introductionmentioning

confidence: 99%

Impulsive suicide attempts predict post-treatment relapse in alcohol-dependent patients

Wojnar

Ilgen

Jakubczyk

et al. 2008

Drug and Alcohol Dependence

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Background-The present study was designed to examine the influence of suicidality on relapse in alcohol-dependent patients. Specifically, a lifetime suicide attempt at baseline was used to predict relapse in the year after treatment. Also, the unique contribution of impulsive suicide attempts was examined.Methods-A total of 154 patients with alcohol dependence, consecutively admitted to four addiction treatment facilities in Warsaw, Poland participated in the study. Of the 154 eligible patients, 118 (76.6%) completed a standardized follow-up assessment at 12 months.Results-Previous suicide attempts were common in adults treated for alcohol dependence with 43% patients in the present sample reporting an attempt at some point during their lifetime. Additionally, more than 62% of those with a lifetime suicide attempt reported making an impulsive attempt. Lifetime suicide attempts were not associated with post-treatment relapse (chisquare=2.37, df=1, p=0.124). However, impulsive suicide attempts strongly predicted relapse (OR=2.81, 95%C.I. = 1.13-6.95, p=0.026) and time to relapse (OR=2.10, 95% C.I. = 1.18-3.74, p=0.012) even after adjusting for other measures of baseline psychopathology, depression, impulsivity, hopelessness and alcohol use severity.Conclusions-This study is the first to document the relationship between pre-treatment impulsive suicide attempts and higher likelihood of post-treatment relapse in alcohol-dependent patents. Clinicians should routinely conduct an assessment for previous suicide attempts in patients with alcohol use disorders, and when impulsive suicidality is reported, they should recognize the increased risk for relapse and formulate their patients' treatment plans accordingly with the goals of reducing both alcoholic relapse and suicide rates.

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“…En segundo lugar, la comorbilidad de un trastomo mental con algún trastorno de personalidad aumenta considerablemente las dificultades en el manejo clínico de estos pacientes (Cangas y Olivencia, 2001;Pedrero y Segura, 2003). En tercer lugar, en el ámbito específico de las adicciones, algunos estudios han encontrado una relación significativa entre la presencia de un trastorno de personalidad y el mayor riesgo de recaída o abandono Verheul, Van den Brink y Hartgers, 1998a). Y, por último, también en el ámbito de las adicciones, se ha llegado a seña-lar la existencia de una eficacia terapéutica diferencial en función del tipo concreto de trastomo de personalidad presente (Poldmgo y Forti, 1988).…”

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Uso y abuso de los autoinformes en la evaluación de los trastornos de personalidad

Montalvo¹,

Echeburúa²

2006

RPPC

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Resumen: En este artículo se lleva a cabo una revisión de las discrepancias observadas en los estudios de comorbilidad entre los trastornos mentales del Eje I y los trastornos de personalidad. Las investigaciones llevadas a cabo hasta la fecha muestran un amplio rango en la tasa de comorbilidad, con variaciones en función del tipo de instrumento de evaluación utilizado. Los estudios que recurren a cuestionarios muestran tasas significativamente más altas de trastornos de personalidad que los llevados a cabo con entrevistas clínicas. Los autoinformes presentan, por tanto, una tendencia a sobrediagnosticar trastornos de personalidad. Las entrevistas clínicas, en cambio, son más estrictas y conservadoras, por lo que las tasas de prevalencia son más bajas y ajustadas, incluso con diferencias significativas cuando se utilizan ambos tipos de instrumentos con una misma muestra clínica. Se ejemplifican estos datos con estudios concretos llevados a cabo en el ámbito del alcoholismo, la ludopatia, la adicción a la cocaína y los trastornos de la conducta alimentaria. Por últi-mo, se comentan las implicaciones de este hecho para la práctica clínica cotidiana y para la investigación futura. Palabras clave: Trastornos de personalidad, autoinformes, entrevistas clínicas, evaluación. Use and abuse ofself-reports in the assessment ofpersonality disorders Abstract:In this paper an analysis of the observed discrepancies in studíes about the comorbidity between mental disorders of Axis I and personality disorders was carried out. Research shows a wide range of the comorbidity rates, with variations in function of the kind of assessment tool used. The studies that use self-reports show significantly higher rates ofpersonality disorders than the ones using clinical interviews. Therefore, self-reports have a tendency to over-diagnose personality disorders. However, clinical interviews are stricter and more conservative and so the prevalence rates are lower, even with significant differences when both types of assessment tools are used with the same clinical sample. These data are illustrated with specific studies carried out in some clinical disorders: alcoholism, pathological gambling, cocaine dependence and eating disorders. Lastly, implications of this study for clinical practice and future research are commented upon.

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Personality disorders predict relapse in alcoholic patients

Cited by 97 publications

References 29 publications

Personality Disorders among Alcoholic Outpatients: Prevalence and Course in Treatment

Personality Disorders among Alcoholic Outpatients: Prevalence and Course in Treatment

Impulsive suicide attempts predict post-treatment relapse in alcohol-dependent patients

Uso y abuso de los autoinformes en la evaluación de los trastornos de personalidad

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