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CORK Bibliography: Substance Abuse and Personality Disorders

81 citations. January 2006 to present

Prepared: September 2008

Adamson SJ; Todd FC; Sellman JD; Huriwai T; Porter J. Coexisting psychiatric disorders, in a New Zealand outpatient alcohol and other drug clinical population. Australian and New Zealand Journal of Psychiatry 40(2): 164-170, 2006. (30 refs.)

Objective: To describe the extent of psychiatric disorder and mental health service utilization in a representative outpatient alcohol and other drug (AOD) treatment sample in New Zealand. Method: A total of 105 patients were randomly recruited from two outpatient AOD treatment services in New Zealand and completed a diagnostic interview within the first 2 months of treatment. Axis I psychiatric diagnoses were made using the computerized Composite International Diagnostic Interview (CIDI-Auto), and were supplemented by the South Oaks Gambling Scale (SOGS) and the conduct disorder and antisocial personality disorder section of the Diagnostic Interview for Genetic Studies (DIGS). Results: Seventy-four percent of the sample had a current non-substance or gambling axis I disorder, with a lifetime rate of 90%. The most commonly diagnosed of these coexisting psychiatric disorders were major depressive episode (34%), social phobia (31%) and posttraumatic stress disorder (31%). Past contact with mental health services was common, while contact at the time of baseline assessment was uncommon. Conclusions: Coexisting psychiatric disorder was the rule and not the exception in this sample. AOD patients are clearly part of the larger population of mental health patients. AOD services need to be capable of comprehensive assessment and treatment planning, which includes coexisting psychiatric disorders, and should work toward better integration with other mental health services.

Anyanwu EC. Childhood environmental neurotoxic exposures and experiences: Major factors in antisocial behavior (review). International Journal on Disability and Human Development 6(3): 231-235, 2007. (28 refs.)

Public and governmental concern has been growing in recent times about the levels of antisocial behavior among the youths resulting in aggressive and criminal behavior, which is especially prevalent in the socially and economically disadvantaged young children and adolescents. This paper assesses and evaluates the possible causes and adverse ramifications of antisocial behavior in society. A plethora of possible factors is evaluated to which child developmental neurotoxic pollutant exposures could lead to antisocial behaviors. Other factors include the influence of peers, parental nurturing and family members in terms of alcohol and substance abuse. Research in these areas is advised towards proper psychosocial and parental interventions.

Arendt M; Rosenberg R; Foldager L; Perto G; Munk-Jorgensen P. Psychopathology among cannabis-dependent treatment seekers and association with later substance abuse treatment. Journal of Substance Abuse Treatment 32(2): 113-119, 2007. (28 refs.)

We determined the proportion of psychiatric treatments for disorders not due to substance use among a cohort of subjects (n = 3,114) seeking treatment for cannabis dependence. Data were retrieved from Danish treatment registers. Cases were compared with a representative sample, which was randomly selected from the general population according to age and gender (it =: 15,570). Cannabis users were followed, and reentry into substance abuse treatment was used as an outcome deploying Cox regression analysis. The proportion of treatment for all psychiatric disorders was much higher among cases than among controls: schizophrenia (odds ratio [OR] 7.9; 95% confidence interval [95% CI] - 6.1-10.2), bipolar disorders (OR = 4.9; 95% CI - 2.8-8.5), other affective disorders (OR 7.6; 95% CI - 6.1-9.5), and personality disorders (OR = 17.3; 95% CI 14.5-20.5). All in all, 40.7% of cases, compared with 5.2% of controls, had received psychiatric treatment (OR - 12.5; 95% CI = 11.3-13.8). A history of psychiatric treatment was associated with increased rates of reentry into substance abuse treatment, in general (OR 1.35-1 95% CI 1.20-1.53), specifically for cannabis (OR - 1.26 95% CI 1.07-1.48) and opioid (OR 1.56; 95% CI 1.23-1.99) dependence. This is the first study to show that the proportion of psychiatric treatment is much elevated among, subjects seeking treatment for cannabis dependence, and that a history of psychiatric problems is associated with higher rates of reentry into substance abuse treatment.

Ball SA. Comparing individual therapies for personality disordered opioid dependent patients. Journal of Personality Disorders 21(3): 305-321, 2007. (53 refs.)

Within a psychotherapy development research project, thirty male (50%) and female (50%) personality disordered outpatients receiving methadone maintenance were randomly assigned to receive one of two 6-month manual-guided individual psychotherapies, Dual Focus Schema Therapy (DFST) or 12 Step Facilitation Therapy (12FT). All participants met diagnostic criteria for at least one personality disorder with antisocial, borderline, avoidant, and dependent being the most common. There were no significant differences between the two therapies for retention, utilization, or reductions in psychiatric symptoms or psychosocial impairment. Both therapy conditions demonstrated significant reductions in various severity indicators. Participants demonstrated more rapid decreases in the frequency of their substance use over six months of DFST in comparison to 12FT. DFST also was associated with a stronger therapeutic alliance between therapists and participants. Contrary to predictions, 12FT demonstrated better reduction of dysphoric affect than did DFST. DFST shows initial promise as the first time-limited manual-guided psychotherapeutic approach for the full range of personality disorders encountered in substance abuse patients.

Barnow S; Herpertz SC; Spitzer C; Stopsack M; Preuss UW; Grabe HJ; Kessler C; Freyberger HJ. Temperament and character in patients with borderline personality disorder taking gender and comorbidity into account. Psychopathology 40(6): 369-378, 2007. (62 refs.)

This study examined correlations of borderline personality disorder (BPD) symptoms with scales from Cloninger's psychobiological model taking gender and psychiatric comorbidity into consideration. Inpatients with BPD (n = 202) were compared to several control groups including psychiatrically healthy persons (n = 327), subjects with affective disorders (n = 46), alcohol use disorders (n = 47), cluster C personality disorders (n = 23) and antisocial personality disorder (n = 25). The results indicate that only males with BPD presented an 'explosive' temperament suggested by Cloninger, with simultaneously high levels of novelty seeking and harm avoidance. In contrast, women with BPD were characterized by high levels of harm avoidance, but not novelty seeking. Regarding temperament and character dimensions our analyses suggest that patients with BPD could be characterized, in particular, by a combination of high harm avoidance and very low self-directedness. The specific temperament configuration of BPD postulated by Cloninger's psychobiological model could only partially be supported. The results provide support for the importance of controlling for gender effects when investigating the applicability of dimensional models with respect to personality disorders.

Barnow S; Ulrich I; Grabe HJ; Freyberger HJ; Spitzer C. The influence of parental drinking behaviour and antisocial personality disorder on adolescent behavioural problems: Results of the Greifswalder Family Study. Alcohol and Alcoholism 42(6): 623-628, 2007. (39 refs.)

Aim: Contradictory results have been produced by previous research on the question to what extent do children of alcoholics (COAs) differ in measures of externalizing symptoms from children of non-alcoholic parents. The goal of this study was to determine whether COAs are characterized by more behavioural problems than non-COAs, and also to determine the influence of a paternal antisocial personality disorder (ASPD) in this context. Methods: In this study, 340 children and adolescents between the ages of 11 and 18 years and their parents were included. Of this sample, 76 adolescents showed a positive family history of alcoholism (FHalc) and 47 adolescents a positive history of a paternal ASPD (FHaspd). Externalizing symptoms, which where measured on the basis of maternal ratings and self-assessments, were analysed with a two-factorial MANCOVA with FHalc and FHaspd as independent factors. Results: The results of the MANCOVA revealed that only children with paternal ASPD showed significant higher scores in attentional problems, self-rated aggression/delinquency and disruptive behaviour, while there were no differences for FHalc and the interaction effect. Conclusions: Our findings show that the higher of behavioural problems relates primarily to a higher prevalence in both cases of ASPD among fathers. These results were discussed regarding the mediating role of a paternal ASPD for the differences in behavioural problems in COAs and non-COAs. Furthermore, children with FHalc and/or FHaspd represent high-risk groups and should be the focus of prevention and intervention measures.

Borman PD; Zilberman ML; Tavares H; Suris AM; el-Guebaly N; Foster B. Personality changes in women recovering from substance-related dependence. Journal of Addictive Diseases 25(4): 59-66, 2006. (11 refs.)

The present study explored the potential for change in personality in women in recovery. Dimensions of the Temperament and Character Model and the five-factor model of personality were examined at baseline and at follow-up after treatment for addiction. Within both models of personality, the factors which have been found to be the best predictors of the presence of a personality disorder (Self-Directedness within the Temperament and Character Model; Neuroticism within the five-factor model) showed significant change at follow-up which suggests the flexibility of personality and the potential for change of personality disorders within women seeking treatment for addiction.

Bornovalova MA; Daughters SB. How does dialectical behavior therapy facilitate treatment retention among individuals with comorbid borderline personality disorder and substance use disorders? (review). Clinical Psychology Review 27(8): 923-943, 2007. (178 refs.)

For individuals presenting with comorbid borderline personality disorder (BPD) and substance use disorders (SUD), rates of treatment dropout from combined mental health and substance abuse treatment centers approach 80%, rendering dropout the rule rather than the exception. Several studies indicate that utilizing a more comprehensive treatment such as Dialectical Behavior Therapy (DBT) may be useful for client retention; however, given the scope and effort required to conduct this treatment, it may be more practical to determine which specific components within DBT are useful in retaining clients in substance use treatment. Thus, the purpose of the current paper is first to determine what exact deficits underlie treatment dropout among the BPD-SUD comorbidity. Second, we review and evaluate effectiveness of DBT retention-enhancing strategies by assembling work from other samples and literatures that also tests retention-enhancing strategies discussed in DBT. As a last step, the paper will conclude with a discussion on methodological limitations and potential future directions in this line of research.

Bottlender M; Preuss UW; Soyka M. Association of personality disorders with type A and type B alcoholics. European Archives of Psychiatry and Clinical Neuroscience 256(1): 55-61, 2006. (37 refs.)

Personality disorders frequently occur as comorbid disorder in alcohol-dependent subjects. Antisocial personality was described as an important characteristic in Cloninger's Type 2 and Babor's Type B subjects. The impact of other personality disorders on these alcoholism typologies, their pathogenesis and prognosis is, however, still unclear. The present study investigated the prevalence of personality disorders in 237 (194 males) detoxified alcohol-dependent patients after subtyping this sample according to Babor's Type A/B following the criteria suggested by Schuckit et al. (1995). Personality disorders were assessed with the SCID-II (DSM-IV). In all, 160 patients (68 %) could be classified as Type A, and 77 (32 %) as Type B.Type B subjects were younger, had an earlier onset, more alcohol intake and a more severe course of alcohol dependence. Type B patients had significantly more often any cluster A and B personality disorder, and significantly specifically more often a borderline, antisocial and avoidant personality disorder. There were no statistical differences concerning the other personality disorders. In summary, the Type A/B dichotomy using the criteria of Schuckit et al. (1995) was replicated successfully. Differences concerning cluster B personality disorder prevalence of Type B subjects demonstrated that these subjects are significantly more often affected from borderline and antisocial personality disorder. The impact of other personality disorders does not play a substantial role in subtyping alcoholics.

Bucholz KK; Nurnberger JI; Kramer JR; Hesselbrock VM; Schuckit MA; Bierut LJ. Comparison of psychiatric diagnoses from interview reports with those from best-estimate procedures. Journal of Studies on Alcohol 67(1): 157-168, 2006. (37 refs.)

Objective: The aim of this study was to compare psychiatric diagnoses based on interview information with those based on best-estimate procedures, to evaluate information used in such procedures, and to use 5-year follow-up data to determine whether the best-estimate diagnosis is an improvement over the interview-based diagnosis. Method: Psychiatric diagnoses were based on interview reports from 373 probands and 2,615 relatives participating in a high-risk family study of alcoholism. The diagnosis also included clinician ratings in a best-estimate procedure of this study. Results: For most diagnoses, both sensitivity and specificity, using the best-estimate diagnosis (BED) as the gold standard, were excellent, in both relatives and probands. Substance abuse was an exception, with very low sensitivity, although specificity rates were excellent. For nonsubstance diagnoses, specificity was high, but sensitivity ranged from 59% to 84% across relatives and probands. In general, BED procedures led to higher prevalence estimates than those from the interview only. In the BED process, family history data were especially useful for conduct and antisocial personality disorders. Follow-up interview data supported the fact that BED procedures led to both enhancements of, as well as errors in, diagnosis. Conclusions: Our data attest to the utility of family history information, particularly for antisocial personality disorder and conduct disorder, and indicate that, for the phenotype of substance-dependence disorder, an interview-based diagnosis alone is adequate in classifying individuals with a minimum of error. These results should be reassuring for research studies in which costs and resources required for best-estimate procedures are not affordable.

Burch GSJ; Hemsley DR; Corr PJ. An anti-social personality for an anti-social habit? The relationship between multi-dimensional schizotypy "normal" personality and cigarette smoking. International Journal of Clinical and Health Psychology 8(1): 23-35, 2008. (47 refs.)

The association between psychoticism (asocial-schizotypy) and cigarette smoking appears to be well established in the literature. However, findings from research examining the relationship between smoking and positive-schizotypy is less consistent, with some studies reporting higher positive-schizotypy in smokers, and other studies reporting no differences. This may be somewhat surprising given that individuals diagnosed with schizophrenia are known to smoke considerably more cigarettes than is typical of the general population, and that positive-schizotypy is phenotypically more closely linked to schizophrenia than asocial-schizotypy. This paper describes necessary further analysis into the relationship between cigarette smoking and multi-dimensional schizotypy (as measured by the Oxford-Liverpool Inventory of Feelings and Experiences), with the additional benefit of "normal" personality data included in the analysis. Personality (both schizotypal and normal) and cigarette smoking data from 182 participants were collated and analysed. Results found that the personality variables associated with asocial-schizotypy were the only reliable predictors of smoking status.

Chapman AL; Cellucci T. The role of antisocial and borderline personality features in substance dependence among incarcerated females. Addictive Behaviors 32(6): 1131-1145, 2007. (45 refs.)

This study examined the association of borderline personality disorder (BPD) and antisocial personality disorder (ASPD) with substance dependence among incarcerated females (N = 105) as well as the influence of the co-occurrence of BPD and ASPD on psychosocial functioning in substance-dependent participants. The severity of BPD and ASPD both were associated with drug dependence, but BPD was not associated with alcohol dependence. After controlling for ASPD severity, BPD severity was no longer associated with dug dependence. The ASPD features of criminal activity and recklessness were most uniquely associated with drug and alcohol dependence (respectively). None of the BPD features was uniquely associated with alcohol or drug dependence after controlling for ASPD. A co-occurring BPD diagnosis was associated with mood disturbance and experiential avoidance among substance-dependent participants. An ASPD diagnosis was associated with an earlier age at first arrest, along with greater childhood abuse and severity of alcohol dependence. These findings have important implications for further understanding and developing ways to help substance-dependent incarcerated females.

Cohen P; Chen H; Crawford TN; Brook JS; Gordon K. Personality disorders in early adolescence and the development of later substance use disorders in the general population. Drug and Alcohol Dependence 88(Supplement 1): S71-S84, 2007. (68 refs.)

Assessments of personality disorder (PD) and conduct disorder (CD) in a random community sample at mean age 13 were employed to predict subsequent substance abuse disorder (SUD), trajectories of symptoms of abuse or dependence on alcohol, marijuana, or other illicit substances, and hazard of initiating marijuana use over the subsequent decade. Personality disorders and conduct disorder were associated with diagnoses and symptoms of SUDS in every model and their effects were independent of correlated family risks, participant sex, and other Axis 1 disorders. Specific elevated PD symptoms in early adolescence were also associated with differential trajectories of already initiated SUD symptoms as well as elevated risk for future onset of SUD symptoms. For several models the greatest of these effects were shown for borderline PD and for conduct disorder, the predecessor of adult antisocial PD. Passive-aggressive PD also showed independent elevation effects on substance use symptoms for alcohol and marijuana. Analyses over 30 years suggest that Cluster B PD (borderline, histrionic, narcissistic) are independent risks for development of SUD and warrant clinical attention.

Compton WM; Thomas YF; Stinson FS; Grant BF. Prevalence, correlates, disability, and comorbidity of DSM-IV drug abuse and dependence in the United States - Results from the National Epidemiologic Survey on Alcohol and Related Conditions. (review). Archives of General Psychiatry 64(5): 566-576, 2007. (106 refs.)

Background: Current and comprehensive information on the epidemiology of DSM-IV 12-month and lifetime drug use disorders in the United States has not been available. Objectives: To present detailed information on drug abuse and dependence prevalence, correlates, and comorbidity with other Axis I and II disorders. Design, Setting, and Participants: Face-to-face interviews using the Alcohol Use Disorder and Associated Disabilities Interview Schedule of the National Institute on Alcohol Abuse and Alcoholism in a large representative sample of US adults (N = 43 093). Main Outcome Measures: Twelve-month and lifetime prevalence of drug abuse and dependence and the associated correlates, treatment rates, disability, and comorbidity with other Axis I and II disorders. Results: Prevalences of 12-month and lifetime drug abuse (1.4% and 7.7%, respectively) exceeded rates of drug dependence (0.6% and 2.6%, respectively). Rates of abuse and dependence were generally greater among men, Native Americans, respondents aged 18 to 44 years, those of lower socioeconomic status, those residing in the West, and those who were never married or widowed, separated, or divorced (all P<.05). Associations of drug use disorders with other substance use disorders and antisocial personality disorder were diminished but remained strong when we controlled for psychiatric disorders. Dependence associations with most mood disorders and generalized anxiety disorder also remained significant. Lifetime treatment- or help-seeking behavior was uncommon (8.1%, abuse; 37.9%, dependence) and was not associated with sociodemographic characteristics but was associated with psychiatric comorbidity. Conclusions: Most individuals with drug use disorders have never been treated, and treatment disparities exist among those at high risk, despite substantial disability and comorbidity. Comorbidity of drug use disorders with other substance use disorders and antisocial personality disorder, as well as dependence with mood disorders and generalized anxiety disorder, appears to be due in part to unique factors underlying each pair of these disorders studied. The persistence of low treatment rates despite the availability of effective treatments indicates the need for vigorous educational efforts for the public and professionals.

Corley RP; Zeiger JS; Crowley T; Ehringer MA; Hewitt JK; Hopfer CJ et al. Association of candidate genes with antisocial drug dependence in adolescents. Drug and Alcohol Dependence 96(1-2): 90-98, 2008. (56 refs.)

The Colorado Center For Antisocial Drug Dependence (CADD) is using several research designs and strategies in its study of the genetic basis for antisocial drug dependence in adolescents. This study reports single nucleotide polymorphism (SNP) association results from a targeted gene assay (SNP chip) of 231 primarily Caucasian male probands in treatment with antisocial drug dependence and a matched set of community controls. The SNP chip was designed to assay 1500 SNPs distributed across 50 candidate genes that have had associations with substance use disorders and conduct disorder. There was an average gene-wide inter-SNP interval of 3000 base pairs. After eliminating SNPs with poor signals and low minor allele frequencies, 60 nominally significant associations were found among the remaining 1073 SNPs in 18 of 49 candidate genes. Although none of the SNPs achieved genome-wide association significance levels (defined as p < .000001), two genes probed with multiple SNPs (OPRM1 and CHRNA2) emerged as plausible candidates for a role in antisocial drug dependence after gene-based permutation tests. The custom-designed SNP chip served as an effective and flexible platform for rapid interrogation of a large number of plausible candidate genes.

Darke S; Ross J; Williamson A; Mills KL; Havard A; Teesson M. Borderline personality disorder and persistently elevated levels of risk in 36-month outcomes for the treatment of heroin dependence. Addiction 102(7): 1140-1146, 2007. (27 refs.)

Aims: To determine the effects of borderline personality disorder (BPD) on 36-month outcomes for the treatment of heroin dependence. Design: Longitudinal cohort study. Setting Sydney, Australia. Participants A total of 429 heroin users enrolled in the Australian Treatment Outcome Study, interviewed at 36-month follow-up. Findings: The BPD group enrolled in significantly more different treatment episodes across follow-up, but there was no difference in the cumulative number of treatment days received. At 36 months, there were no group differences in sustained or current heroin abstinence, daily heroin use or level of polydrug use. BPD patients maintained significantly higher levels of crime, injection-related health problems, heroin overdose, major depression and poorer global mental health. In contrast to 12-month follow-up, at 36 months there were no group differences in the proportions who attempted suicide over the preceding 12 months or had recently borrowed used injection equipment. Conclusions The clinical picture provided some cause for optimism since 12-month follow-up. Despite this, BPD patients maintained elevated risk levels across a number of domains. The fact that these risks were maintained indicates that this is a group that requires specific clinical attention for BPD-related risks.

Daughters SB; Stipelman BA; Sargeant MN; Schuster R; Bornovalova MA; Lejuez CW. The interactive effects of antisocial personality disorder and court-mandated status on substance abuse treatment dropout. Journal of Substance Abuse Treatment 34(2): 157-164, 2008. (48 refs.)

The present study sought to examine the interactive effects of court-mandated (CM) treatment and antisocial personality disorder (ASPD) on treatment dropout among 236 inner-city male substance users receiving residential substance abuse treatment. Of the 236 participants, 39.4% (n = 93) met criteria for ASPD and 72.5% (n = 171) were mandated to treatment through a pretrial release-to-treatment program. Results indicated a significant interaction between ASPD and CM status, such that patients with ASPD who were voluntarily receiving treatment were significantly more likely to drop out of treatment than each of the other groups. Subsequent discrete time survival analyses to predict days until dropout, using Cox proportional hazards regression, indicated similar findings, with patients with ASPD who were voluntarily receiving treatment completing fewer days of treatment than each of the other groups. These findings suggest the effectiveness of the court system in retaining patients with ASPD, as well as the role of ASPD in predicting treatment dropout for individuals who are in treatment voluntarily. Implications, including the potential value of the early implementation of specialized interventions aimed at improving adherence for patients with ASPD who are receiving treatment voluntarily, are discussed.

De Rick A; Vanheule S. Alexithymia and DSM-IV personality disorder traits in alcoholic inpatients: A study of the relation between both constructs. Personality and Individual Differences 43(1): 119-129, 2007. (32 refs.)

This study examines the relationship between alexithymia (BVAQ) and DSM-IV personality disorder traits (ADP-IV) in a sample of alcoholic inpatients (N= 101). We investigate which personality disorder traits are associated with alexithymia when biographical variables, psychological distress and severity of alcohol use-problems are controlled for, bearing in mind that such variables might induce an alexithymic state in individuals. The results indicate that the control variables are insufficiently related to alexithymia, which is interpreted as an indication for alexithymia being a trait rather than a state. At a more detailed level the results of this study indicate significant positive associations between alexithymia and schizoid, avoidant and antisocial personality traits and a negative relationship with schizotypal personality traits. Cross-validation in a non-clinical population (N = 101) that was matched to the clinical group for gender, age and highest educational degree, indicates that these results could not be replicated. Limitations of the study and suggestions for further research are highlighted.

Di Sclafani V; Finn P; Fein G. Psychiatric comorbidity in long-term abstinent alcoholic individuals. Alcoholism: Clinical and Experimental Research 31(5): 795-803, 2007. (49 refs.)

Background: A high prevalence of comorbid psychiatric disorders has been demonstrated in individuals with an alcohol use disorder in both community and treatment samples, with higher comorbidity in treatment samples. In this study, we examined lifetime and current psychiatric diagnoses in long-term abstinent alcoholic individuals ( mean abstinence=6.3 years; n=52) compared with age and gender-comparable non-alcoholic controls (n=48). We asked the following questions: (1) to achieve long-term abstinence, must an individual be relatively psychiatrically healthy (i.e., comparable with non-alcoholic controls) and (2) can ongoing abstinence be maintained in the face of a current psychiatric disorder? Methods: Lifetime and current (prior 12 months) psychiatric diagnoses were assessed in the mood, anxiety, and externalizing disorder domains using the computerized Diagnostic Interview Schedule (c-DIS). Results: Over 85% of those with long-term abstinence had a lifetime psychiatric diagnosis, compared with 50% of non-alcoholic controls. Long-term abstinent alcoholic individuals had a higher prevalence than non-alcoholic controls of lifetime mood, anxiety, and externalizing disorder diagnoses. Long-term abstinent alcoholic individuals also had a greater prevalence than non-alcoholic controls of current mood and anxiety diagnoses. Although long-term abstinent alcoholics had a greater lifetime prevalence of an antisocial personality disorder (ASPD) than non-alcoholics, no long-term abstinent alcoholicsor NC had a current ASPD diagnosis. Finally, there was no association of duration of abstinence with lifetime or current psychiatric diagnoses, consistent with psychiatric diagnoses having little effect on relapse. Conclusions: Our results suggest that: (1) the presence of a lifetime psychiatric diagnosis does not militate against achieving long-term abstinence, (2) abstinence can be maintained in the presence of a current mood or anxiety disorder, and (3) a current diagnosis of ASPD may not be compatible with long-term abstinence. The relatively low levels of antisocial behavior compared with preabstinence (as indicated by no long-term abstinent alcoholics meeting current criteria for ASPD) raises the question of whether the neurobiology underlying antisocial behavior is changed in abstinence, or brought under increased executive control, or both.

Dick DM; Wang JC; Plunkett J; Aliev F; Hinrichs A; Bertelsen S et al. Family-based association analyses of alcohol dependence phenotypes across DRD2 and neighboring gene ANKK1. Alcoholism: Clinical and Experimental Research 31(10): 1645-1653, 2007. (69 refs.)

There is an extensive and inconsistent literature on the association of the dopamine D2 receptor gene (DRD2) with alcohol dependence. Conflicting results have been attributed to differences in the severity of the alcohol dependence phenotype across studies, failure to exclude related disorders from comparison groups, and artifacts of population-stratification. Recently the genetic polymorphism most widely analyzed in DRD2, Taq1A, has been discovered to reside in a neighboring gene, ankyrin repeat and kinase domain containing 1 (ANKK1), located 10 kb downstream from DRD2. To more carefully characterize evidence for association across this region, we genotyped 26 single nucleotide polymorphisms (SNPs) spanning DRD2 and ANKK1 in a sample of 219 Caucasian families (n = 1,923) from the Collaborative Study on the Genetics of Alcoholism (COGA), making this the most extensive analysis to date of association between this region and alcohol dependence. We used family-based analyses robust to population-stratification, and we made use of rich phenotypic data to analyze alcohol dependence and subtypes hypothesized in the literature to be more directly influenced by DRD2. We found that the evidence for association is strongest in the 5' linkage disequilibrium block of ANKK1 (that does not contain Taq1A), with weak evidence of association with a small number of SNPs in DRD2. The association in ANKK1 is strongest among the subsets of alcoholics with medical complications and with antisocial personality disorder. More extensive genotyping across DRD2 and ANKK1 suggests that the association with alcohol dependence observed in this region may be due to genetic variants in the ANKK1 gene. ANKK1 is involved in signal transduction pathways and is a plausible biological candidate for involvement in addictive disorders.

Dom G; De Wilde B; Hulstijn W; Van Den Drink W; Sabbe B. Behavioral aspects of impulsivity in alcoholics with and without a cluster-B personality disorder. Alcohol and Alcoholism 41(4): 412-420, 2006. (92 refs.)

Aims: Studies have shown that alcoholics with a cluster-B personality disorder (cluster-B PD) are characterized by high levels of impulsivity. However, impulsivity has mainly been studied as a broad concept without its different aspects being considered. The present study compared abstinent alcoholic inpatients without any personality disorder (PD) and abstinent alcoholics with cluster-B PD on different aspects of impulsivity, i.e. self-reported impulsivity and neuropsychological indicators such as behavioural control and delay of gratification. Methods: Forty alcohol-dependent inpatients without PD and 22 alcohol-dependent inpatients with a cluster-B PD were compared on two self-report impulsivity questionnaires (Barratt impulsiveness scale; sensation-seeking scales) and three behavioural impulsivity tasks [Go/No-Go task; delay discounting task (DDT); Stroop colour word test]. Tests were administered after stable abstinence of at least 3 weeks. Results: Self-report measures of impulsivity were higher in cluster-B alcoholics than in alcoholics without PD. Behavioural tasks revealed a more differentiated pattern of impairments. On the Go/No-Go task, cluster-B alcoholics were impaired in inhibitory control but not in reaction time compared with alcoholics without PD. In contrast, no significant differences on the DDT and the Stroop were observed. Conclusion: Alcohol-dependent patients with and without a cluster-B PD differ in terms of behavioural inhibition but not in terms of activation or the ability to delay gratification. This finding may partly account for their impulsive and (self-) destructive behaviours. Treatment planning should pay specific attention to these impairments in behavioural control.

Dom G; De Wilde B; Hulstijn W; van den Brink W; Sabbe B. Decision-making deficits in alcohol-dependent patients with and without comorbid personality disorder. Alcoholism: Clinical and Experimental Research 30(10): 1670-1677, 2006. (51 refs.)

Background: Impairments in decision making are a consistent finding in substance use disorder (SUD) populations. However, decision-making deficits are not specific for SUDs and are also reported in the context of other psychiatric disorders such as antisocial and borderline personality disorders (PDs). Given the frequent comorbidity between SUD and cluster B PD, it might be questioned whether the decision-making impairments typically reported in SUD populations reflect the addictive disorder, the cluster B PD, or a combination of the 2. Methods: In the current study, we compare the decision-making performance of non-substance-abusing controls (n=53) on the Iowa Gambling Task (IGT) with the decision-making performance of 3 abstinent alcohol-dependent samples, i.e., alcoholic patients without any PD (n=38), alcoholic patients with a cluster A or C PD (n=19), and alcoholic patients with a cluster B PD (n=23). Results: Overall, all 3 alcohol-dependent subsamples performed inferior compared with controls. Between alcoholic subsamples, the alcoholic patients with a cluster A or C PD had the highest IGT score, followed by the alcoholic patients without a PD, while the cluster B alcoholic patients were the most impaired. Copnclusions: These findings suggest that impairments in decision making underlie both alcohol dependence and cluster B PD, and alcoholic patients with a comorbid cluster B PD are particularly impaired in their decision making. These deficits may underlie the severe problems that characterize cluster B alcoholic patients specifically in inappropriate behaviors (e.g., poly substance abuse, legal, and professional dysfunction).

Earleywine M. Schizotypy, marijuana, and differential item functioning. Human Psychopharmacology: Clinical and Experimental 21(7): 455-461, 2006. (41 refs.)

At least five studies report elevated schizotypy scores in cannabis users. The current research confirms higher schizotypy scores in regular cannabis users. Nevertheless, further analyses reveal that select items on the brief version of the Schizotypal Personality Questionnaire do not function comparably in current and former users. Multiple statistical approaches confirmed this problem, including the Mantel-Haenszel statistic, Rasch difficulty estimates, a logistic regression approach, the Breslow-Day (BD) statistic, and a combined decision rule using Mantel-Haenszel and BD together. Cannabis users appear to misinterpret at least one item, "I sometimes use words in unusual ways" making them more likely to endorse it even if they are no more schizotypal than the former users. Users might consider cannabis-related slang as an unusual use of words. Removing problematic items does not decrease the internal consistency of the measure, but eliminates the significant difference between current and former users. These results suggest that links between cannabis use and schizotypy require cautious interpretation and may arise from measurement problems.

Echeburua E; de Medina RB; Aizpiri J. Comorbidity of alcohol dependence and personality disorders: A comparative study. Alcohol and Alcoholism 42(6): 618-622, 2007. (20 refs.)

Aims: To describe the frequency and profile of personality disorders related to alcohol dependence, and to compare them with non-addictive disorders and with normal population. Methods: In this cross-sectional clinical-epidemiological study, using the International Personality Disorder Examination and the Millon Clinical Multiaxial Inventory-II for personality disorders, 158 consecutively recruited alcohol-dependent patients attending a psychiatric outpatient clinic were compared with 120 consecutively recruited psychiatric patients with non-addictive disorders, and 103 subjects from the general population chosen to match the patient samples for age, gender and socioeconomic level. Results: Of the alcohol-dependent patients, 44.3%, and of the general clinical sample, 21.7% (vs 6.8% of the normative sample) showed at least one personality disorder. Obsessive-compulsive personality disorders were most prevalent (12%), followed by antisocial, paranoid and dependent personality disorders (7% each). Most of them showed only one personality disorder.

Elonheimo H; Niemela S; Parkkola K; Multimaki P; Helenius H; Nuutila AM et al. Police-registered offenses and psychiatric disorders among young males - The Finnish "From a boy to a man" birth cohort study. Social Psychiatry and Psychiatric Epidemiology 42(6): 477-484, 2007. (42 refs.)

Objective: To study associations between crime and psychiatric disorders among adolescent males in a representative population-based cohort study. Method The sample includes 2,712 Finnish boys born in 1981. Information on criminality consists of offenses registered in the Finnish National Police Register 1998-2001. Crime was classified according to frequency and type (drug, violent, property, traffic, and drunk driving offenses). Information on psychiatric diagnoses between 1999 and 2004 was collected from the Finnish National Military Register. Results: Of the 2,712 boys, 22% had a crime registration during the 4-year period, and 10% had at least one psychiatric disorder according to the Military Register. Those with psychiatric disorders accounted for 49% of all crimes. Of those with more than five crimes (n = 98), 59% had psychiatric diagnoses. After adjusting for other crime types and childhood socio-economic status, property crime was independently associated with several diagnoses: antisocial personality (APD), substance use (SUD), psychotic, anxiety, and adjustment disorders. Drug offending was independently associated with APD, SUD, and psychotic disorder, and traffic offenses with APD. Conclusions: Youth crime is predominantly associated with antisocial personality and substance use disorders. Crime prevention efforts should focus on boys showing a risk for antisocial and substance use problems. In particular, property, drug, and repeat offenders need mental health and substance use assessment. There is a need to develop integrated mental health and substance use treatment services for young offenders within or alongside the criminal justice system.

Evren C; Kural S; Erkiran M. Antisocial personality disorder in Turkish substance dependent patients and its relationship with anxiety, depression and a history of childhood abuse. Israel Journal of Psychiatry and Related Sciences 43(1): 40-46, 2006. (37 refs.)

The prevalence of antisocial personality disorder (ASPD) in treatment-seeking Turkish substance dependent patients and the relationship of ASPD with clinical characteristics were studied. Participants were 132 inpatients with substance dependence according to the Structured Clinical Interview for DSM-IV (SCID-I), Turkish version. The clinician applied a semi-structured socio-demographic form, SCID-I, SCID-II, Childhood Abuse and Neglect Questionnaire (CANQ), Michigan Alcoholism Screening Test (MAST), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Among the 132 substance dependent patients, 31 (23.5%) had ASPD diagnosis and 56 (42.4%) had no personality disorder or personality traits. Rate of childhood physical abuse, childhood verbal abuse, childhood neglect, suicide attempt history, self-destructive behavior and lifetime major depression were higher among patients with ASPD. Also mean scores of BDI, BAI and MAST were higher among patients with ASPD. The high rate of ASPD found among Turkish substance dependent patients suggests that special attention must be paid to identify ASPD in this group. Findings in this study showed that there is an association between ASPD and childhood abuse, lifetime major depression and severity of substance use.

Fernandez-Montalvo J; Landa N; Lopez-Goni JJ; Lorea I. Personality disorders in alcoholics: A comparative pilot study between the IPDE and the MCMI-II. Addictive Behaviors 31(8): 1442-1448, 2006. (19 refs.)

In this paper, the most frequent personality disorders (PDs) related to alcoholism are described. 105 participants took part in the study (50 consecutively recruited treatment-seeking alcoholics and 55 subjects from the general population). All subjects were assessed with the IPDE and the MCMI-II. According to the results in the IPDE, 22% of alcoholics, versus 7.27% of the normal sample, showed at least one PD. The most prevalent PDs were the Avoidance personality disorder (10%), followed by the Non-specified (8%) and Borderline (6%). When the MCMI-II was used a significantly higher prevalence of PDs was observed (52% in alcoholics and 18.1% in the normal sample), without coincidence in the kind of PDs diagnosed. This lack of consistency is probably related to the assessment tools, mainly the IPDE, which is more accurate and conservative than self-report inventories, which present a tendency for over-diagnosis.

Feske U; Tarter RE; Kirisci L; Pilkonis PA. Borderline personality and substance use in women. American Journal on Addictions 15(2): 131-137, 2006. (66 refs.)

The association between borderline personality disorder (BPD) and substance use disorder (SUD) was examined in a predominantly psychiatric (77.6%) sample of 232 women. BPD proved to be a significant predictor of a lifetime diagnosis of SUD across four different categories: any SUD ( including alcohol); alcohol use; drug use; and heroin, cocaine, or poly-substance use. BPD continued to be a predictor of SUD even when the effects of other cluster B and all cluster C PDs were controlled statistically. Antisocial personality disorder generally yielded larger odds ratios than BPD and emerged as a partial mediator of the relation between BPD and SUD. Histrionic PD was the only other PD that showed meaningful relations with SUD.

Fountoulakis KN; Leucht S; Kaprinis GS. Personality disorders and violence. Current Opinion in Psychiatry 21(1): 84-92, 2008. (56 refs.)

Purpose of review To review the most recent literature on the relationship between personality disorders and violent behavior. The review does not aim to address the issue of a possible etiological connection between previously being the victim of violent acts and later developing a personality disorder. Recent findings Recent data suggest that personality disorders, especially antisocial and borderline, are strongly related to the manifestation of violent acts. Substance abuse is another strong factor which could act either independently or additively. Biological factors seem to constitute a risk factor for violent behavior independently of personality. Although intelligence does not seem to be related to violence, some patients may manifest specific cognitive deficits. The ethical and legal questions posed by the above correlations are difficult to answer, and research has not yet provided enough data on this issue. Summary The most recent data support the relationship between antisocial personality and violence, especially when substance abuse is also present, although the presence of confounding factors in the diagnostic criteria suggest caution in the interpretation of the literature.

Fridell M; Hesse M; Jaeger MM; Kuhlhorn E. Antisocial personality disorder as a predictor of criminal behaviour in a longitudinal study of a cohort of abusers of several classes of drugs: Relation to type of substance and type of crime. Addictive Behaviors 33(6): 799-811, 2008. (31 refs.)

Mixed findings have been made with regard to the long-term predictive validity of antisocial personality disorder (ASPD) on criminal behaviour in samples of substance abusers. A longitudinal record-linkage study of a cohort of 1052 drug abusers admitted 1977-1995 was undertaken. Subjects were recruited from a detoxification and short-term rehabilitation unit in Lund, Sweden, and followed through criminal justice registers from their first treatment episode to death or to the year 2004. In a ML multinomial random effects regression, subjects diagnosed with antisocial personality disorders were 2.16 times more likely to be charged with theft only (p < 0.001), and 2.44 times more likely to be charged committing multiple types of crime during an observation year (p<0.001). The findings of the current study support the predictive validity of the DSM-III-R diagnosis of ASPD. ASPD should be taken seriously in drug abusers, and be targeted in treatment to prevent crime in society.

Fridell M; Hesse M; Johnson E. High prognostic specificity of antisocial personality disorder in patients with drug dependence: Results from a five-year follow-up. American Journal on Addictions 15(3): 227-232, 2006. (25 refs.)

A sample of 125 consecutive patients from a Swedish detoxification unit were followed up at five years. Register data on criminal behavior were retrieved for 99% of all subjects, including those who were deceased at follow-up, and 76% of living subjects were interviewed. A diagnosis of antisocial personality disorder (ASPD) at intake was associated with incarceration, continuous drug use, dependence on welfare support, and fulfilling criteria of adult ASPD at follow-up. Regardless of ASPD status, a decline was seen in drug-related convictions, but subjects with ASPD were found to continue to commit other crimes.

Garcia KSL; da Costa ML. Antisocial behavior and alcohol consumption by school adolescents. Revista Latino-Americana de Enfermagem 16(2): 299-305, 2008. (16 refs.)

Adolescence is a vulnerable period and facilitates the start of risk behaviors, for instance the use of drugs. This study aims to describe the differences between antisocial behavior and alcohol consumption according to gender, age and education; as well as to discover the relation between antisocial behavior and alcohol consumption in 1,221 school adolescents from Monterrey.- Nuevo Leon, Mexico. The findings reveal differences in antisocial behavior according to gender. Evidences showed that 41.3% of the students had consumed alcohol at sometime in their lives, and that differences exist in alcohol consumption according to age and education. Finally, the study found positive and significant relations between antisocial behavior and alcohol consumption (r(s) = .272, p < .001).

Gilder DA; Lau P; Gross A; Ehlers CL. A co-morbidity of alcohol dependence with other psychiatric disorders in young adult Mexican Americans. Journal of Addictive Diseases 26(4): 31-40, 2007. (44 refs.)

Background: Mexican Americans comprise one of the most rapidly growing populations in the U.S. However, information on the co-morbidity of alcohol dependence with other psychiatric disorders in Mexican Americans is sparse. Methods: Demographic information, DSM-III-R diagnoses, and information differentiating independent from Substance-induced anxiety and affective disorders were obtained from 240 Mexican American Young adults residing in select areas of San Diego. Results: A high prevalence of alcohol dependence was found in this population. There was significant co-morbidity between alcohol dependence and anxiety, affective, conduct/antisocial, and other substance dependence disorders. Eight percent of the anxiety disorders and 26% of the affective disorders were found to be substance-induced. Conclusion: High rates and substantial co-morbidity of alcohol dependence with psychiatric and other substance use disorders were found in this population. These data may be helpful in designing prevention and intervention programs for this high-risk population.

Goldstein RB; Compton WM; Pulay AJ; Ruan WJ; Pickering RP; Stinson FS; Grant BF. Antisocial behavioral syndromes and DSM-IV drug use disorders in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. (review). Drug and Alcohol Dependence 90(2/3): 145-158, 2007. (103 refs.)

Background: Antisocial behavioral syndromes, including antisocial personality disorder (ASPD), syndromal adult antisocial behavior (AABS) without conduct disorder (CD) before age 15, and CD without progression to ASPD ("CD only") are highly comorbid with drug use disorders (DUDs). Among patients in DUD treatment, antisocial syndromes are associated with greater severity and poorer outcomes. Comparative data concerning associations of antisocial syndromes with clinical characteristics of DUDs among general population adults have not previously been available. This study describes associations of antisocial syndromes with clinical characteristics of lifetime Diagnostic and Statistical Manual-Version IV DUDs in the general U.S. adult population. Methods: This report is based on the 2001-2002 National Epidermologic Survey on Alcohol and Related Conditions (n = 43,093, response rate = 81%). Respondents (n = 4068) with lifetime DUDs were classified according to whether they met criteria for ASPD, AABS, "CD only," or no antisocial syndrome. Associations of antisocial syndromes with clinical characteristics of DUDs were examined using logistic regression. Results: Antisocial syndromes were significantly associated with the phenomenology of DUDs, particularly ASPD with the most severe clinical presentations. Associations with AABS were similar to those with ASPD; those with "CD only" were weak, inconsistent, and not statistically significant. Patterns of associations differed little between men and women. Conclusions: Both ASPD and AABS, but not "CD only," appear to identify greater clinical severity of DUDs among adults in the general U.S. population.

Grant BF; Stinson FS; Dawson DA; Chou SP; Ruan WJ; Pickering RP. Co-occurrence of 12-month alcohol and drug use disorders and personality disorders in the United States - Results from the National Epidemiologic Survey on Alcohol and Related Conditions (reprinted from Archives of General Psychiatry, vol 61, pg 361, 2004). Alcohol Research & Health 29(2): 121-130, 2006. (84 refs.)

Background: Very little information is available on the co-occurrence of different personality disorders (PDs) and alcohol and drug use disorders in the U.S. population. Objective: To present national data on sex differences in the co-occurrence of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) alcohol and drug use disorders and 7 of the 10 DSM-IV PDs. Design: Face-to-lace interviews conducted in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (N = 43,093). Setting: The United States and the District of Columbia, including Alaska and Hawaii. Participants: Household and group-quarters residents, age 18 and older. Results: Among individuals with a current alcohol use disorder, 28.6 percent (95 percent confidence interval [CI], 26.7-30.6) had at least one PD, whereas 47.7 percent (95 percent CI, 43.9-51.6) of those with a current drug use disorder had at least one PD. Further, 16.4 percent (95 percent CI, 15.1-17.6) of individuals with at least one PD had a current alcohol use disorder, and 6.5 percent (95 percent CI, 5.7-7.3) had a current drug use disorder. Associations between PDs and alcohol and drug use disorders were overwhelmingly positive and significant (P <.05). Overall, alcohol use disorders were most strongly related to antisocial (odds ratio [OR], 4.8; 95 percent CI, 4.1-5.6), histrionic (OR, 4.7; 95 percent CI 3.&-5.8), and dependent (OR, 3.0; 95 percent CI, 1.9-4.8) PDs. Drug use disorders also were more highly associated with antisocial (OR, 11.8; 95 percent CI, 9.7-14.3), histrionic (OR, 8.0; 95 percent CI, 6.0-10.7), and dependent (OR, 11.6; 95 percent CI, 7.1-19. 1) PDs. Associations between obsessive-compulsive, histrionic, schizoid, and antisocial PDs and specific alcohol and drug use disorders were significantly stronger (P <.04) among women than men, whereas the association between dependent PD and drug dependence was significantly greater (P <.04) among men than women. Conclusions: The co-occurrence of PDs with alcohol and drug use disorders is pervasive in the U.S. population. Results highlight the need for further research on the underlying structure of these disorders and the treatment implications of these disorders when comorbid.

Public Domain

Gregory RJ; Chlebowski S; Kang D; Remen AL; Soderberg MG; Stepkovitch J et al. A controlled trial of psychodynamic psychotherapy for co-occurring borderline personality disorder and alcohol use disorder. Psychotherapy 45(1): 28-41, 2008. (54 refs.)

A randomized controlled trial was conducted to determine whether a manual-based psychodynamic treatment, labeled dynamic deconstructive psychotherapy (DDP), would be feasible and effective for individuals with co-occurring borderline personality disorder (BPD) and alcohol use disorder. Thirty participants were assessed every 3 months during a year of treatment with either DDP or treatment as usual (TAU) in the community. DDP participants showed statistically significant improvement in parasuicide behavior, alcohol misuse, institutional care, depression, dissociation, and core symptoms of BPD, and treatment retention was 67% to 73%. Although TAU participants received higher average treatment intensity, they showed only limited change during the same period. The results support the feasibility, tolerability, and efficacy of DDP for the co-occurring subgroup and highlight the need for further research.

Grekin ER; Sher KJ; Wood PK. Personality and substance dependence symptoms: Modeling substance-specific traits. Psychology of Addictive Behaviors 20(4): 415-424, 2006. (45 refs.)

Personality traits related to neuroticism and disinhibition have been consistently associated with substance use disorders (SUDs). It is unclear, however, whether different personality traits predict distinct forms of substance dependence. Additionally, it is unclear whether personality traits continue to predict alcohol, drug, and tobacco dependence after controlling for comorbid antisociality and other SUDs. The current study addresses these questions by characterizing relations between personality traits and substance dependence symptoms in a longitudinal sample of 3,720 college students. Results revealed that antisociality and certain core personality traits predicted multiple types of substance pathology. In addition, several personality traits were differentially associated with alcohol, drug, and tobacco symptomatology.

Havens JR; Cornelius LJ; Ricketts EP; Latkin CA; Bishai D; Lloyd JJ et al. The effect of a case management intervention on drug treatment entry among treatment-seeking injection drug users with and without comorbid antisocial personality disorder. Journal of Urban Health 84(2): 267-271, 2007. (16 refs.)

We examined the effect of a case management intervention on drug treatment entry among injection drug users (IDUs) with and without comorbid antisocial personality disorder (ASPD). Injection drug users attending the Baltimore Needle Exchange Program who sought and were granted referrals to opioid agonist treatment were randomized to receive a strengths-based case management intervention or passive referral. Of 162 IDUs, 22.8% met the DSM-IV criteria for ASPD. Compared to those without ASPD, IDUs with comorbid ASPD who spent 25 or more minutes with their case manager prior to their treatment entry date were 3.51 times more likely to enter treatment than those receiving less than 5 min, adjusting for intervention status, race, and treatment site (95% confidence interval 1.04-11.89). Providing case management services to IDUs with comorbid ASPD may facilitate treatment entry and reduce the negative consequences of drug abuse.

Herrero MJ; Domingo-Salvany A; Torrens M; Brugal MT. Psychiatric comorbidity in young cocaine users: Induced versus independent disorders. Addiction 103(2): 284-293, 2008. (54 refs.)

Aims: To examine the psychiatric status of young cocaine users using a validated instrument for the evaluation of psychiatric comorbidity, emphasizing the distinction between independent and induced psychiatric conditions. Design: Cross-sectional study. Setting Barcelona, Spain. Participants A cohort of 139 young (18-30 years) adult current regular cocaine users. Measurements The Psychiatric Research Interview for Substance and Mental Disorders (PRISM-IV, which produces diagnoses according to DSM-IV criteria, including Axis II antisocial and borderline personality disorders). Findings: Nearly 42.5% of the subjects presented psychiatric comorbidity. The most common Axis I diagnoses were mood disorders (26.6%) and anxiety disorders (13%). Increasing age, having ever received treatment for drug use and freebase cocaine use were associated with substance-induced disorders diagnoses relative to primary Axis I disorders. Conclusions: This study has shown a relatively high prevalence of psychiatric comorbidity in cocaine users recruited in non-clinical settings. Future studies examining potential differential factors associated with primary versus substance-induced disorders are necessary to optimize the implementation of more suitable approaching programmes for young regular cocaine users.

Huang DB; Kamat PP; Wang J. Demographic characteristics and antisocial personality disorder of early and late onset alcoholics identified in a primary care clinic. American Journal on Addictions 15(6): 478-482, 2006. (21 refs.)

A total of 1,734 persons were prospectively screened in a primary care clinic to examine the demographic characteristics and presence or absence of antisocial personality disorder among early onset alcoholics (EOA) and late onset alcoholics (LOA). A total of 76 EOA (male = 58 and female = 18) and 80 LOA (male = 56 and female = 24), as determined by the Comprehensive Drinking Profile Scale, participated in the study. EOA tended to be single and were younger, in a lower socioeconomic class, raised by non-biological parents, more likely to have antisocial personality disorder, and more likely to commit certain convicted offenses compared to LOA (p <= .05). This study found that EOA identified in a primary care clinic have a different demographic profile and are more likely to have antisocial personality disorder compared to LOA.

Hussong A; Bauer D; Chassin L. Telescoped trajectories from alcohol initiation to disorder in children of alcoholic parents. Journal of Abnormal Psychology 117(1): 63-78, 2008. (58 refs.)

The current study tested whether and why children of alcoholics (COAs) showed telescoped (adolescent) drinking initiation-to-disorder trajectories as compared with non-COAs. Using longitudinal data from a community-based sample, the authors confirmed through survival analyses that COAs progressed more quickly from initial adolescent alcohol use to the onset of disorder than do matched controls. Similar risks for telescoping were evident in COAs whose parents were actively symptomatic versus those whose parents had been previously diagnosed. Stronger telescoping effects were observed for COAs whose parents showed comorbidity for either depression or antisocial personality disorder. Both greater externalizing symptoms and more frequent, heavier drinking patterns at initiation failed to explain COAs' risk for telescoping, although externalizing symptoms were a unique predictor of telescoping. This risk for telescoping was also evident for drug disorders. These findings characterize a risky course of drinking in COAs and raise important questions concerning the underlying mechanisms and consequences of telescoping in COAs.

James LM; Taylor J. Associations between symptoms of borderline personality disorder, externalizing disorders, and suicide-related behaviors. Journal of Psychopathology and Behavioral Assessment 30(1): 1-9, 2008. (52 refs.)

Borderline personality disorder and externalizing disorders are associated with suicide-related behaviors. The present study examined whether symptoms of borderline personality disorder mediate the relationship between externalizing disorders and suicide-related behaviors. Diagnostic interviews were administered to 344 participants (n=233 women). Results indicated that symptoms of antisocial personality disorder, alcohol use disorders, and drug use disorders each were significantly associated with suicide threats and self-injurious behavior in women and symptoms of antisocial personality disorder were associated with suicide attempts in women. With the exception of the association between symptoms of alcohol dependence and self-injurious behaviors, borderline personality disorder symptoms mediated or partially mediated all associations between externalizing disorders and suicide-related behaviors in women. These results highlight the importance of assessment and treatment of borderline personality disorder symptoms in individuals with externalizing disorders, particularly in the presence of suicide-related behaviors.

James LM; Taylor J. Impulsivity and negative emotionality associated with substance use problems and Cluster B personality in college students. Addictive Behaviors 32(4): 714-727, 2007. (49 refs.)

The co-occurrence of personality disorders (PDs) and substance use disorders (SUDs) can be partially attributed to shared underlying personality traits. This study examined the role of negative emotionality (NEM) and impulsivity in 617 university students with self-reported substance use problems and Cluster B PD symptoms. Results indicated that NEM was significantly associated with drug and alcohol use problems, antisocial PD, borderline PD, and narcissistic PD. Impulsivity was significantly associated with drug use problems, antisocial PD, and histrionic PD. Only NEM mediated the relationship between alcohol use problems and symptoms of each of the Cluster B PDs while impulsivity mediated only the relationship between drug use problems and histrionic PD. These results suggest that NEM may be more relevant than impulsivity to our understanding of the co-occurrence between substance use problems and Cluster B PD features.

Jansson I; Hesse M; Fridell M. Personality disorder features as predictors of symptoms five years post-treatment. American Journal on Addictions 17(3): 172-175, 2008. (18 refs.)

Personality disorders are associated with dysfunction in a variety of areas. Recent longitudinal research has shown that personality disorders are also predictive of problems later in life, as well as of poor response to treatment of depression and anxiety. This study assessed whether personality disorder features were associated with psychiatric symptoms in a cohort of women treated for substance abuse in Sweden. Patients were diagnosed with personality disorders using the Structured Clinical Interview for DSM-IV (SCID-II) personality questionnaire and SCID-II interview, and were then administered a self-report questionnaire designed to measure symptoms of psychiatric illness, the Symptoms Checklist-90 (SCL-90), during and five years after treatment. Concurrently, features of all personality disorders, except histrionic, were associated with SCL-90 score. At five-year follow-up, most personality disorders remained associated with SCL-90 score, with the exception of paranoid and schizoid personality disorder. After controlling for baseline score on the SCL-90, conduct disorder, borderline personality disorder, and narcissistic personality disorder remained significantly associated with symptoms at follow-up. After controlling for abstinence and baseline score, only borderline personality disorder features remained associated with SCL-90 score at follow-up. Patients with personality disorders should be monitored after treatment for psychiatric symptoms.

Kennealy PJ; Hicks BM; Patrick CJ. Validity of factors of the Psychopathy Checklist-Revised in female prisoners - Discriminant relations with antisocial behavior, substance abuse, and personality. Assessment 14(4): 323-340, 2007. (67 refs.)

The validity of the Psychopathy Checklist-Revised (PCL-R) has been examined extensively in men, but its validity for women remains understudied. Specifically, the correlates of the general construct of psychopathy and its components as assessed by PCL-R total, factor, and facet scores have yet to be examined in depth. Based on previous research conducted with male offenders, a large female inmate sample was used to examine the patterns of relations between total, factor, and facet scores on the PCL-R and various criterion variables. These variables include ratings of psychopathy based on Cleckley's criteria, symptoms of antisocial personality disorder, and measures of substance use and abuse, criminal behavior, institutional misconduct, interpersonal aggression, normal range personality, intellectual functioning, and social background variables. Results were highly consistent with past findings in male samples and provide further evidence for the construct validity of the PCL-R two-factor and four-facet models across genders.

Krampe H; Wagner T; Stawicki S; Bartels C; Aust C; Kroener-Herwig B et al. Personality disorder and chronicity of addiction as independent outcome predictors in alcoholism treatment. Psychiatric Services 57(5): 708-712, 2006. (15 refs.)

Objective: A prospective four-year study examined which components of addiction severity predicted time to relapse among 112 adults with chronic alcoholism who participated in a comprehensive outpatient treatment program. Methods: Recruited from emergency, inpatient, and outpatient facilities, patients were admitted into the program consecutively between March 1998 and June 2002. Alcohol abstinence was carefully monitored for four years from admission by regular contacts and urine and blood analyses. Alcoholism characteristics and personality disorders were assessed with structured interviews and the International Diagnostic Checklists for Personality Disorders. Results: Among a variety of potential variables, only presence of a personality disorder and chronicity of addiction were independently associated with a decrease of cumulative four-year abstinence probability. Conclusions: Their high predictive values suggest that chronicity and personality disorder rank among the most important characteristics of addiction severity.

Langbehn DR; Philibert R; Caspers KM; Yucuis R; Cadoret RJ. Association of a D2S2944 allele with depression specifically among those with substance abuse or antisocial personality. Drug and Alcohol Dependence 83(1): 33-41, 2006. (45 refs.)

Associations have previously been reported between a 124-bp allele at D2S2944 and recurrent, early-onset depression in women. These earlier reports also noted but did not emphasize a possible association between this allele and alcohol-specific depression. We have analyzed the Iowa Adoption Study data to test this association. D2S2944 allele typing was available for 247 subjects from the Iowa Adoption Studies. Information on lifetime affective, alcohol, drug, and antisocial personality (ASPD) disorders was available from a structured interview. We used logistic regression to analyze adjusted and interactive D2S2944 associations with depression. Controlling other risk factors, the 124-bp allele had a strong association with DSM-IV major depression specific to those with histories of alcohol abuse/dependence and/or ASPD. (Overlap between the two prevented further specification of the interaction.) The association was not gender-specific and was not limited to alcohol-related depressive episodes. This relationship appears stronger than the D2S2944 association previously reported for early-onset depression in women. We note that in combination with additional liabilities towards depression in women and alcoholism/sociopathy in men, the 124-bp allele may provide a basis for the phenomenon of depressive spectrum illness proposed by Winokur.

Larkins JM; Sher KJ. Family history of alcoholism and the stability of personality in young adulthood. Psychology of Addictive Behaviors 20(4): 471-477, 2006. (48 refs.)

The authors examined the magnitude and durability of personality differences related to family history of alcoholism (FH) and the development of alcohol use disorders (AUDs) in late adolescence and early adulthood. Data were taken from a longitudinal sample (N = 487; approximately half FH-positive [+]) who completed the Eysenck Personality Questionnaire (H. J. Eysenck & S. B. G. Eysenck, 1975) at 3 points spanning 11 years (participants were 18 years old at baseline). Hierarchical linear analyses showed that FH+ participants had higher levels of neuroticism and psychoticism over the study period, independent of AUD. Despite relatively large mean decreases in neuroticism (as well as extraversion), the magnitude of the between-groups differences found at age 18 were maintained over the next decade. These changes thus reflect stable underlying differences in personality and not artifacts of higher rates of AUDs in FH+ individuals, recently living in an alcoholic home, vulnerability to the developmental challenge of leaving home, and/or a developmental lag.

Lysova AV; Hines DA. Binge drinking and violence against intimate partners in Russia. Aggressive Behavior 34(4): 416-427, 2008. (50 refs.)

This study is the first to provide information on the association between intimate partner violence (IPV) and binge drinking among Russian university students. Using data from 500 (58% female) university students from the four Russian sites of the International Dating Violence Study, we found gender differences in rates of IPV perpetration and in the association between binge drinking and IPV. Specifically, more females than males perpetrated IPV, and the associations between binge drinking and IPV were stronger for the female students than for the male students. In addition, antisocial traits and behavior (ATSB) were significantly related to both binge drinking and IPV perpetration for males and females. For males, the relatively weak associations between binge drinking and IPV perpetration disappeared once ASTB was accounted for. For females, the relationship decreased but remained significant when ATSB was statistically controlled. Path analyses confirmed that this pattern of relationships would be consistent with ATSB serving as a partial mediator between binge drinking and IPV perpetration. However, other alternative mediation and moderation models for the relationships between binge drinking, IPV perpetration, and ATSB could not be ruled out with this one-wave correlational study.

Mariani JJ; Horey J; Bisaga A; Aharonovich E; Raby W; Cheng WY et al. Antisocial behavioral syndromes in cocaine and cannabis dependence. American Journal of Drug and Alcohol Abuse 34(4): 405-414, 2008. (30 refs.)

Antisocial personality disorder (ASPD) is highly associated with substance use disorders (SUD). In addition to the full ASPD syndrome, which requires both childhood conduct disorder and the adult features, other antisocial behavioral syndromes, including conduct disorder (CD) alone without the adult syndrome, and the adult antisocial behavioral syndrome without childhood CD (AABS) are also frequently diagnosed in patients with SUD. The aim of this study was to compare the rates of these various ASPD syndromes between cocaine- and cannabis-dependent individuals seeking treatment. A structured interview for ASPD excluding symptoms that occurred solely in the context of substance use was conducted in 241 outpatients (cocaine dependence, n = 111; cannabis dependence, n = 130). Overall, the proportion of substance-dependent individuals in this study with AABS was significantly larger than the proportion with ASPD (30.9% vs. 17.3%). A diagnosis of CD-only, where CD did not progress to ASPD, was uncommon. No significant differences in the prevalence of antisocial behavioral syndrome diagnoses were found between cocaine-and cannabis-dependent patients. Antisocial behavioral syndrome diagnosis did not influence treatment retention. Antisocial behavioral syndromes are commonly diagnosed in patients with SUD and future research should evaluate prognostic implications of AABS compared to ASPD in a variety of clinical treatment settings.

Mikulich-Gilbertson SK; Salomonsen-Sautel S; Sakai JT; Booth RE. Gender similarities and differences in antisocial behavioral syndromes among injection drug users. American Journal on Addictions 16(5): 372-382, 2007. (47 refs.)

Studies report that more female substance users meet the adult antisocial behavioral ( AASB) criteria of antisocial personality disorder (ASPD) without having conduct disorder. We assessed gender and antisocial syndrome (ASPD vs. AASB) effects jointly on multiple outcomes in injection drug users. More males had ASPD (40%) and more females had AASB ( 67%). After adjusting for gender, the ASPD group was consistently more severe, indicating discriminative validity for the diagnosis. However, the AASB group reported substantial pathology, signifying AASB as an important sub-threshold antisocial syndrome. Antisocial behavior might be described as a distribution, with AASB and ASPD defined by increasingly extreme points.

Mueser KT; Crocker AG; Frisman LB; Drake RE; Covell NH; Essock SM. Conduct disorder and antisocial personality disorder in persons with severe psychiatric and substance use disorders. Schizophrenia Bulletin 32(4): 626-636, 2006. (77 refs.)

Conduct disorder (CD) and antisocial personality disorder (ASPD) are established risk factors for substance use disorders in both the general population and among persons with schizophrenia and other severe mental illnesses. Among clients with substance use disorders in the general population, CD and ASPD are associated with more severe problems and criminal justice involvement, but little research has examined their correlates in clients with dual disorders. To address this question, we compared the demographic, substance abuse, clinical, homelessness, sexual risk, and criminal justice characteristics of 178 dual disorder clients living in 2 urban areas between 4 groups: No CD/ASPD, CD Only, Adult ASPD Only, and Full ASPD. Clients in the Adult ASPD only group tended to have the most severe drug abuse severity, the most extensive homelessness, and the most lifetime sexual partners, followed by the Full ASPD group, compared with the other 2 groups. However, clients with Full ASPD had the most criminal justice involvement, especially with respect to violent charges and convictions. The results suggest that a late-onset ASPD subtype may develop in clients with severe mental illness secondary to substance abuse, but that much criminal behavior in clients with dual disorders may be due to the early onset of the full ASPD syndrome in this population and not the effects of substance use disorders.

Public Domain

Neufeld KJ; Kidorf MS; Kolodner K; King VL; Clark M; Brooner RK. A behavioral treatment for opioid-dependent patients with antisocial personality. Journal of Substance Abuse Treatment 34(1): 101-111, 2008. (83 refs.)

Antisocial personality disorder (APD) is associated with increased problem severity in treatment-seeking opioid-dependent patients. Treatment studies have reported mixed results but generally show that patients with APD make progress that is often comparable to drug-dependent patients without the personality disorder. Much of this work is based on secondary analyses of studies evaluating responses to a variety of drug abuse treatment interventions. This study reports on a randomized prospective trial evaluating a behavioral approach for managing opioid-dependent patients with APD. Subjects (N = 100) met Diagnostic and Statistical Manual of Mental Disorders criteria for opioid dependence and APD using a structured clinical interview and were randomly assigned to either an experimental condition (n = 51), which used a highly structured contingency management intervention, or a control condition (n = 49), which reflected standard methadone treatment. Subjects in the experimental group had significantly better counseling attendance and some indication of lower psychosocial impairment compared to the control group. The experimental intervention increased attendance in subjects with low and high levels of psychopathy and with and without other psychiatric comorbidity. These findings support the development of interventions more tailored to drug-dependent patients with APD.

Nielsen P; Rojskjaer S; Hesse M. Personality-guided treatment for alcohol dependence: A quasi-randomized experiment. American Journal on Addictions 16(5): 356-364, 2007. (25 refs.)

Personality disorders are highly prevalent among alcohol-dependent populations and result in a seriously elevated risk for non- responding to treatment; therefore, they represent a major challenge for professionals providing treatment for alcohol dependence. Personality-guided Treatment for Alcohol Dependence ( PETAD), an approach that integrates cognitive therapy for addictive behaviors with strategic intervention for maladaptive personality features, may be helpful for patients with co- morbid alcohol dependence and personality disorders. Clients admitted for inpatient treatment for alcohol dependence at Ringgaarden, Denmark (n = 108) were allocated to either standard inpatient treatment with cognitive therapy for alcohol dependence, or PETAD. Both treatments were manualized. Clients were followed up by mail at six months post- treatment and administered the MCMI- I and II and the SCL-90 at intake, post- treatment, and at follow-up. PETAD was associated with better retention, longer time to first relapse, and less time spent drinking post-treatment, although few differences reached statistical significance. Differences in results were mainly found in the subgroup with higher levels of PD. The study suggests that PETAD is a promising approach that warrants further study.

Nordholm D; Nielsen B. Personality disorders among Danish alcoholics attending outpatient treatment. European Addiction Research 13(4): 222-229, 2007. (28 refs.)

The aim of the present study was firstly to describe the characteristics of alcoholic outpatients (A) suffering from comorbid 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.

O'Gara C; Knight J; Stapleton J; Luty J; Neale B; Nash M et al. Association of the serotonin transporter gene, neuroticism and smoking behaviours. Journal of Human Genetics 53(3): 239-246, 2008. (57 refs.)

Cigarette consumption and smoking cessation are influenced in part by genes. Personality traits have also been implicated in the aetiology of smoking. Neuroticism, a personality trait with a heritable component, correlates well with anxiety and depression, increasing the risk of being a smoker and decreasing the chance of smoking cessation. Several prior studies in non-British populations have given conflicting results as to whether some genetic polymorphisms affect the relationship between smoking and neuroticism. This study investigated the influence of serotonin transporter (5HTTLPR) genotypes on a composite measure of neuroticism and cigarette consumption/smoking cessation in a British population. Although neuroticism was significantly associated with cigarette consumption and smoking cessation, genotype did not affect this relationship. Our results do not support initial interest in utilising 5HTTLPR genotypes in combination with neuroticism ratings for predicting outcome in smoking cessation clinical settings.

Pardini D; White HR; Stouthamer-Loeber M. Early adolescent psychopathology as a predictor of alcohol use disorders by young adulthood. Drug and Alcohol Dependence 88(Supplement 1): S38-S49, 2007. (73 refs.)

Few prospective studies have examined the relation between early adolescent conduct disorder (CD) symptoms and the development of alcohol use disorders (AUD) by young adulthood. The relative contribution of other forms of adolescent psychopathology (i.e., attention-deficit hyperactivity disorder, depression, anxiety/withdrawal) to the development of AUD also remains poorly understood. There is some suggestion that the co-occurrence of conduct disorder symptoms with other forms of psychopathology may interact synergistically in predicting later alcohol use problems. The current study explores these issues using data on 506 boys from the oldest sample of the Pittsburgh Youth Study (PYS). Consistent with prior research, early conduct disorder symptoms emerged as a consistent predictor of increased AUD symptoms and an alcohol dependence diagnosis by young adulthood. In contrast, adolescent boys with high levels of anxiety/withdrawal had lower levels of AUD symptoms and were less likely to develop alcohol dependence by young adulthood. Increased depression in early adolescence was associated with higher AUD symptoms and alcohol abuse and dependence diagnoses by young adulthood, but only for boys with high levels of conduct disorder symptoms. No evidence was found for a relation between attention-deficit hyperactivity disorder symptoms and AUD symptoms or diagnoses after controlling for co-occurring psychopathology.

Petras H; Kellam SG; Brown CH; Muthen BO; Ialongo NS; Poduska JM. Developmental epidemiological courses leading to antisocial personality disorder and violent and criminal behavior: Effects by young adulthood of a universal preventive intervention in first- and second-grade classrooms. (review). Drug and Alcohol Dependence 95(Supplement 1): s45-s59, 2008. (110 refs.)

Background: Antisocial personality disorder (ASPD), violent and criminal behavior, and drug abuse disorders share the common antecedent of early aggressive, disruptive behavior. In the 1985-1986 school year teachers implemented the Good Behavior Game (GBG), a classroom behavior management strategy targeting aggressive, disruptive behavior and socializing children to the student role. From first through seventh grade the developmental trajectories of 2,311 students from 19 Baltimore City Public Schools were examined. We report the GBG impact on these trajectories and ASPD and violent and criminal behavior by age 19-21. Methods: In five urban, poor to lower middle class predominately African-American areas, three to four schools were matched and within each set randomly assigned to one of three conditions: (1) GBG, (2) a reading achievement program, or (3) the standard program. Classrooms and teachers were randomly assigned to intervention or control. Measures at 19-21 included self reports and juvenile court and adult incarceration records. GBG impact was assessed via General Growth Mixture Modeling based on repeated measures of aggressive, disruptive behavior. Results: Three trajectories of aggressive, disruptive behavior were identified. By young adulthood, GBG significantly reduced the rates of ASPD and violent and criminal behavior among males in the persistent high aggressive, disruptive trajectory. Replication: A replication was implemented with the following cohort of first-grade children using the same teachers, but with diminished mentoring and monitoring. Beneficial impact was found among persistent high males through seventh grade. By young adulthood GBG effects on ASPD and violent and criminal behavior were non-significant, but generally in the hypothesized direction.

Preuss UW; Koller G; Barnow S; Eikmeier M; Soyka M. Suicidal behavior in alcohol-dependent subjects: The role of personality disorders. Alcoholism: Clinical and Experimental Research 30(5): 866-877, 2006. (66 refs.)

Background: Comobidity of personality disorders (PDs) and alcohol dependence are considered to increase the risk for suicidal behavior. The aim of this study is to assess the influence of Diagnostic and Statistical Manual of Mental Disorder-fourth edition (DSM-IV) personality characteristics and comorbid axis I disorders on suicidal behavior in alcohol-dependent inpatients. Methods: Characteristics of alcohol dependence and suicidal behavior were obtained using the Semi-Structured Assessment on Genetics in Alcoholism (SSAGA). Personality disorder characteristics were assessed using the Structured Clinical Interview for DSM-IV Axis 11 Disorders. Results: Three-hundred seventy-six treatment-seeking alcohol-dependent subjects, of whom 55% were diagnosed to have a PD and approximately 25% had a history of at least 1 suicide attempt, were enrolled into the study. Subjects with PDs in all clusters reported a higher rate of suicide attempt history, depression episodes, and depression during the most serious attempt. As indicated by univariate and multivarate analysis, this pattern of suicide attempt characteristics was most pronounced in borderline disordered subjects and alcoholic individuals who live alone. Conclusion: Subjects with alcohol dependence who have various comorbid PDs and depression deserve special attention in psychiatric care to prevent suicide. Psychotherapeutic strategies may have to be adapted to treat this high-risk population.

Ralevski E; Ball S; Nich C; Limoncelli D; Petrakis I. The impact of personality disorders on alcohol-use outcomes in a pharmacotherapy trial for alcohol dependence and comorbid Axis I disorders. American Journal on Addictions 16(6): 443-449, 2007. (31 refs.)

Although antisocial and borderline personality disorders frequently co-occur with alcohol dependence and other Axis I disorders, their effect on alcohol use outcomes in context of pharmacotherapy remains unclear. Patients with Major Axis I disorders, including alcohol dependence, and diagnosis of antisocial (ASPD) or borderline personality disorder (BPD) were enrolled in a 12-week medication trial for treatment of their alcohol dependence. Everyone was randomized to one of four cells: naltrexone alone, placebo alone, open label disulfiram and naltrexone, or open label disulfiram and placebo. Outcome measures included scales for alcohol use and craving. Data were analyzed comparing patients with ASPD vs. those without, and patients with BPD vs. those without. Diagnosis of personality disorder did not adversely affect alcohol outcomes, and patients with ASPD or BPD did not have a poorer response to medication than patients without diagnosis of ASPD or BPD. The findings suggest that naltrexone and disulfiram can be safely and effectively used with patients who have comorbid diagnoses of Axis I and Axis II disorders.

Reback CJ; Kamien JB; Amass L. Characteristics and HIV risk behaviors of homeless, substance-using men who have sex with men. Addictive Behaviors 32(3): 647-654, 2007. (22 refs.)

During January and February 2003, 20 non-treatment seeking homeless, substance-using MSM accessing community-based prevention services in West Hollywood, California were assessed to characterize demographics, addiction and psychiatric severity using structured and semi-structured clinical interviews, and high-risk drug and sexual behavior. Participants averaged 37 years old, were mostly Caucasian/white (65%) and most identified as bisexual (58%) or gay (37%). Self-reported HIV scroprevalence was 21%. Most (53%) exchanged sex for money and/or drugs within the previous 30 days. All were diagnosed with current DSM-IV Substance Dependence Disorders, primarily alcohol (62%), amphetamine (57%), cocaine (52%), and marijuana (38%). Participants reported many (35.7) positive psychiatric symptoms on the Brief Symptom Inventory and averaged moderate Beck Depression Inventory scores (19.1). Most (75%) met criteria for Mood Disorder, 33% for Major Depressive Disorder, 43% for Antisocial Personality Disorder and averaged low (48.5) Global Assessment of Functioning scores. While the small convenience sample limits generalizability of the findings, these data provide an opportunity to gain insight into this at-risk population and, thereby, assess appropriate intervention strategies.

Rodriguez-Llera MC; Domingo-Salvany A; Brugal MT; Silva TC; Sanchez-Niubo A; Torrens M. Psychiatric comorbidity in young heroin users. Drug and Alcohol Dependence 84(1): 48-55, 2006. (32 refs.)

In order to determine the prevalence of psychiatric comorbidity in a population of young heroin users recruited from outside of the healthcare context, a sample was assembled by targeted sampling and nomination techniques; it was comprised of regular current users of heroin aged between 18 and 30 years and resident in Barcelona, Spain. Psychiatric evaluation was done with the Psychiatric Research Interview for Substance and Mental Disorders (PRISM) semi-structured interview. Of 149 individuals evaluated, 33% were women, whose mean age was 25.1 years; 93% received a diagnosis of heroin dependence and 71% of cocaine dependence. Thirty-two percent of the subjects had never been treated for substance use. Around two-thirds (67.1%, 95% CI: 59.6-74.7%) of the sample had lifetime psychiatric comorbidity, with antisocial personality and mood disorders being the most frequent conditions (33% and 26%, respectively). Mood, anxiety and eating disorders were more common among women than men. There were no differences in ever having been in treatment for drug use according to the presence of psychiatric comorbidity, although comorbidity was lower among those currently in treatment. Young heroin users recruited on the street presented a high prevalence of psychiatric comorbidity which was unrelated to past treatment history.

Rubio G; Jimenez M; Rodriguez-Jimenez R; Martinez I; Iribarren MM; Jimenez-Arriero MA et al. Varieties of impulsivity in males with alcohol dependence: The role of Cluster-B personality disorder. Alcoholism: Clinical and Experimental Research 31(11): 1826-1832, 2007. (38 refs.)

Background/Rationale: Impulsivity has been associated with alcohol dependence, but impulsivity in alcohol-dependent subjects with a Cluster-B personality disorder (PD) has not been well characterized. Using a variety of laboratory measures of impulsivity, we assessed whether alcohol-dependent patients (ADP) with borderline personality disorder (BPD) exhibited the same pattern of behavioral impulsivity than ADP with antisocial personality disorder (AntPD). Also, differences between ADP without PDs and healthy controls were assessed. Methods: A cross-sectional patient survey with a community comparison group. Diagnoses were made using the Structured Interview for DSM-IV. Sustained attention and rapid-response impulsivity were assessed using the continuous performance test. Inhibitory control was measured by the stop-signal task. Ability to delay reward task was assessed using differential reinforcement for low-rate responding (DRLR). A final sample of 247 males with alcohol-dependence recruited from 2 alcoholism treatment centers was compared with a matched nonsubstance-abusing comparison group (n = 96). Results: Alcohol-dependent patients with BPD made more omission errors than ADP with AntPD, but individuals with AntPD exhibited the poorest efficiency in DRLR. ADPs with a Cluster-B PD displayed more impairment across all behavioral measures than ADP without PD and than controls. In contrast, with respect to controls ADP without a Cluster-B PD showed more impairment only in DRLR. Conclusions: Our findings support the suggestion of 2 paradigms in alcohol dependence. The first, based on inability to delay gratification, might be a vulnerability marker for alcohol dependence. The second was related to inhibitory control and might be specific for AntPD and BPDs.

Sansone RA; Whitecar P; Wiederman MW. The prevalence of borderline personality among buprenorphine patients. International Journal of Psychiatry in Medicine 38(2): 217-226, 2008. (35 refs.)

Objective: In this study, we examined the prevalence of borderline personality disorder (BPD) in a sample of patients seeking outpatient treatment with buprenorphine for opioid addiction. Method: To assess for BPD, we used three self-report surveys in a consecutive study sample. Results: Of the 111 participants who completed all three measures of BPD, 49 (44.1%) exceeded the cut-off score indicative of BPD. Conclusions: Among individuals who are addicted to opioids and seeking treatment with buprenorphine, the prevalence of BPD, as mutually confirmed by three self-report measures, is quite high.

Seguin M; Lesage A; Chawky N; Guy A; Daigle F; Girard G et al. Suicide cases in New Brunswick from April 2002 to May 2003: The importance of better recognizing substance and mood disorder comorbidity. Canadian Journal of Psychiatry 51(9): 581-586, 2006. (28 refs.)

Objective: To investigate all suicide cases that occurred in New Brunswick in the 14 months spanning April 1, 2002, to May 31, 2003, to determine 6-month and lifetime prevalence rates of psychopathology in the deceased. Method: We used 2 psychological autopsy methods: direct proxy-based interviews and medical chart reviews, together with telephone contacts with informants. Consensus DSM-IV diagnoses were formulated by clinical panels on the basis of the Structured Clinical Interviews I and II for DSM-IV complemented by medical charts. Results: Of the 109 suicide deaths identified by the coroner at the time of the study, we were able to investigate 102. At time of death, 65% of the suicide victims had a mood disorder, 59% had a substance-related disorder, and 42% had concurrent mood and substance-related disorders. The lifetime prevalence of substance-related disorders among these suicide victims was 66%. Finally, 52% of the suicide victims presented with a personality disorder; one-half of these were of the cluster B type. Conclusions: Although treatment of depression has frequently been recognized as the focal point of clinically based suicide-prevention efforts, our results underscore substance-related disorders as a key dimension of completed suicide. Suicide-prevention programs should be designed to address this problem more directly.

Simmons LA; Havens JR. Comorbid substance and mental disorders among rural Americans: Results from the National Comorbidity Survey. Journal of Affective Disorders 99(1-3): 265-271, 2007. (44 refs.)

Background: The purpose of this study was to examine whether rural inhabitants were more likely than urban inhabitants to meet the criteria for comorbid mental health and substance abuse or dependence disorders. Methods: Data were from the National Comorbidity Survey, and included 5185 (532=rural; 4653=urban) persons age 14-54 years of age who were interviewed using the Composite International Diagnostic Interview (CIDI). Logistic regression that accounted for the complex survey data and weighting scheme was utilized. Results: Participants residing in rural areas were more likely to meet the DSM-III-R criteria for past month alcohol abuse or dependence if they also met the diagnostic criteria for past month major depressive disorder or lifetime antisocial personality disorder, adjusting for age, race, gender, education and income. Similarly, rural participants were more likely to meet the criteria for comorbid drug abuse or dependence in the past month if they met the diagnosis for either past month major depressive disorder, generalized anxiety disorder or lifetime antisocial personality disorder, controlling for demographic characteristics. Rural residents with any current mental disorder also were less likely to seek treatment than their urban counterparts. Limitations: Data were collected in 1991 and do not capture changes in prevalence of comorbidities. Also, the small number of rural residents sampled resulted in small cell sizes for some comorbidities. Conclusions: Rural residents were significantly more likely to meet the criteria for substance disorders given they also met the criteria for a mental disorder, and those with any current mental disorder were less likely to seek treatment. Since the overall prevalence of these disorders does not differ between rural and urban inhabitants, findings suggest that rural persons may lack access to adequate treatment for their mental health disorders and subsequently may be self-medicating with alcohol and/or drugs.

Stewart SH. Alcoholics in acute medical settings have increased risk for other drug, mood, and personality disorders. International Journal of Psychiatry in Medicine 37(1): 59-67, 2007. (29 refs.)

Objective: Brief medical management and alcohol pharmacotherapy are effective treatments for alcoholic participants enrolled in randomized controlled trials, and this suggests that alcoholism treatment may be delivered successfully in medical settings. However, medical patients may differ from clinical trial participants in ways that suggest a need for more intensive alcoholism treatment. To explore this possibility, this study evaluated the prevalence of mental health disorders in the U.S. population stratified by alcoholism and recent hospitalization or emergency room use. Methods: Data from the National Epidemiological Survey on Alcohol and Related Conditions were analyzed. Subjects with information on alcohol use disorders, emergency room use, hospitalization, and several mental health diagnoses were included (n = 41,961). Methods appropriate for complex survey data were used to determine the relative risk for mental health diagnoses as a function of a current alcohol use disorder and receipt of acute medical care (hospitalization or emergency room visits) within the past year. Results: Results showed that, relative to alcoholic adults who did not have an emergency room visit or hospitalization, alcoholic adults with use of these services had an increased prevalence of personality disorders, depression, and other drug use disorders. Conclusion: Research is needed to evaluate if these and other differences, will lead to poorer treatment outcomes for this group relative to the more selected populations included in medical management efficacy trials.

Tikkanen R; Holi M; Lindberg N; Virkkunen M. Tridimensional Personality Questionnaire data on alcoholic violent offenders: Specific connections to severe impulsive cluster B personality disorders and violent criminality. BMC Psychiatry 7: article 36, 2007. (21 refs.)

Background: The validity of traditional categorical personality disorder diagnoses is currently reevaluated from a continuous perspective, and the evolving DSM-V classification may describe personality disorders dimensionally. The utility of dimensional personality assessment, however, is unclear in violent offenders with severe personality pathology. Methods: The temperament structure of 114 alcoholic violent offenders with antisocial personality disorder (ASPD) was compared to 84 offenders without ASPD, and 170 healthy controls. Inclusion occurred during a court-ordered mental examination preceded by homicide, assault, battery, rape or arson. Participants underwent assessment of temperament with the Tridimensional Personality Questionnaire (TPQ) and were diagnosed with DSM-III-R criteria. Results: The typical temperament profile in violent offender having ASPD comprised high novelty seeking, high harm avoidance, and low reward dependence. A 21% minority scored low in trait harm avoidance. Results, including the polarized harm avoidance dimension, are in accordance with Cloninger's hypothesis of dimensional description of ASPD. The low harm avoidance offenders committed less impulsive violence than high harm avoidance offenders. High harm avoidance was associated with comorbid antisocial personality disorder and borderline personality disorder. Conclusion: Results indicate that the DSM based ASPD diagnosis in alcoholic violent offenders associates with impulsiveness and high novelty seeking but comprises two different types of ASPD associated with distinct second-order traits that possibly explain differences in type of violent criminality. Low harm avoidance offenders have many traits in common with high scorers on the Hare Psychopathy Checklist-Revised (PCL-R). Results link high harm avoidance with broad personality pathology and argue for the usefulness of self-report questionnaires in clinical praxis.

Tragesser SL; Sher KJ; Trull TJ; Park A. Personality disorder symptoms, drinking motives, and alcohol use and consequences: Cross-sectional and prospective mediation. Experimental and Clinical Psychopharmacology 15(3): 282-292, 2007. (52 refs.)

Research shows high comorbidity between Cluster B personality disorders (PDs) and alcohol use disorders (AUDs). Studies on personality traits and alcohol use have identified coping and enhancement drinking motives as mediators in the relations among impulsivity, affective instability, and alcohol use. To the extent that PDs reflect extreme expression of these traits, drinking motives should mediate the relation between PD symptoms and alcohol involvement. This was tested using path models estimating the extent to which coping and enhancement drinking motives mediated the relation between Cluster B symptom counts and alcohol use and problems both concurrently and at a 5-year follow-up. Three hundred fifty-two adults participated in a multiwave study of risk for alcoholism (average age = 29 years at Wave 1). Enhancement motives mediated (a) the cross-sectional relation between Cluster B symptoms and drinking quantity/frequency, heavy drinking, total drinking consequences, dependence features, and AUD diagnosis and (b) the prospective relation to AUDs. Although coping motives mediated the relation between Cluster B symptoms and drinking consequences and dependence features cross-sectionally, prospective effects were limited to indirect effects through Time 1.

Trathen B; O'Gara C; Sarkhel A; Sessay M; Rao H; Luty J. Co-morbidity and cannabis use in a mental health trust in South East England. Addictive Behaviors 32(10): 2164-2177, 2007. (51 refs.)

Aim: The prevalence of co-morbidity (severe mental illness and substance) may be less in rural and semi-rural areas than inner cities. The aims were therefore to measure the prevalence of co-morbidity among patients of attending a mental health service in a semi-rural area South East England. Design and participants: Cross-sectional prevalence survey of 1808 patients with detailed assessments from a representative sample of 373 patients identified as having a combination of severe mental illness and substance misuse. Interviews with key workers were performed using validated methods from the COSMIC study. Results: The response rates equalled or exceeded 90% for the various parts of the study. One-tenth of patients attending the Community Mental Health Teams (CMHTs) reported problematic use of illicit drugs and 17% reported alcohol problems in the past year. 22% of Community Drug and Alcohol Service (CDAS) clients reported a severe mental illness and 46% reported some other form of psychiatric disorder. Of patients with a combined diagnosis of mental illness and substance misuse, cannabis use was 4-fold more common amongst patients attending the CMHT than CDAS (33% vs. 8%) while use of amphetamine was five-fold higher in the CMHT group (10% vs. 2%). Patients with concurrent psychiatric and substance misuse problems represent a similar proportion of the aggregate caseload of both treatment services with observed prevalence amongst the CDAS and CMHT patients with a diagnosis for anxiety disorder (18% vs. 26%), minor depression (42% vs. 32%), personality disorders (32% vs. 36%), histories of self-harm (52% vs. 46%) and violence (33% vs. 30%) respectively. Conclusions: Co-morbidity is common in clients amongst CMHT and CDAS clients although use of cannabis was significantly more common in CMHT clients than in CDAS clients.

Ullrich S; Marneros A. Underlying dimensions of ICD-10 personality disorders: Risk factors, childhood antecedents, and adverse outcomes in adulthood. Journal of Forensic Psychiatry & Psychology 18(1): 44-58, 2007. (41 refs.)

Previous studies have identified specific underlying dimensions of personality disorders with remarkable consistency. This study aimed to replicate the factor structure of personality disorders using ICD-10 dimensional scores from a sample of 366 male offenders. Factor analysis yielded three factors. Factor 1 demonstrated dissocial, paranoid, histrionic, and impulsive personality traits. Factor 2 reflected borderline, anxious, and avoidant PD symptoms. Factor 3 showed high loadings on schizoid PD traits and an inverse relation to anankastic personality. The factor structure was identical to a recent study using ICD-10 personality disorder scores and showed strong similarities to previous studies using DSM-III personality disorder dimensions. Factor I was substantially correlated with the psychopathy total score. Elevated scores on this factor were associated with adverse childhood experiences, early behavioural problems (conduct/hyperkinetic disorder), co-morbid substance abuse in adulthood, an earlier start of criminal career, and a higher number of sentences/offences. No risk factors or childhood antecedents could be identified for Factor 2. However, this factor was distinctively characterised by co-morbid affective and neurotic mental disorders in adulthood. Factor 3 was negatively associated with measures of cognitive functioning. The findings suggest specific pathways, courses, and outcomes of the identified personality disorder dimensions.

Uzun O; Doruk A; Perdeci Z; Turkbay T. Substance use disorders in men with antisocial personality disorder: A study in Turkish sample. Substance Use & Misuse 41(8): 1171-1178, 2006. (26 refs.)

This study investigated the prevalence of substance use disorders (SUDs) and "substance of choice" in 500 male Turkish psychiatric outpatients manifesting a DSM-IV diagnosed antisocial personality disorder (APD) and a SUD diagnoses (the Structured Clinical Interview for DSM-IV). Lifetime SUDs were diagnosed in 86% of APD subjects. Alcohol, cannabis, and inhalant use disorders were the most frequent among substance use, 75.6%, 67.4%, and 35.6%, respectively. This sample's "substance of choice" differed from reported Western populations; a result which may be influenced by socio-cultural variations. The study's limitations are noted.

van den Bosch LMC; Verheul R. Patients with addiction and personality disorder: Treatment outcomes and clinical implications. (review). Current Opinion in Psychiatry 20(1): 67-71, 2007. (36 refs.)

Purpose of review: The present review examines the outcomes of treatments focusing on substance abuse, on personality disorders, and on both the foci simultaneously. Clinical guidelines for the treatment of dually diagnosed patients are described. Recent findings: Recent studies continued the tradition of examining the importance of factors such as the chronicity of substance abuse and the impact of sex with regard to the prognosis of the treatment of substance abuse and the development of effective treatment programs. Overall, the multifaceted and risky nature of dual problems is stressed, and as a logical consequence, an early detection of dual problems is promoted. Several studies show the risk of suicidal and harmful behavior associated with this population, even when the treatment for substance abuse has been successful. For the first time, the issue of dropout is studied from the client's perspective. Summary: Knowledge about the effectiveness of dually focused treatments is emerging. Results show that the treatment of dually diagnosed patients with severe problems needs to include both the foci because it leads to enormous gains for the patients when personality disorders are also addressed. Yet, integrated treatment programs are lacking and research is still too limited.

Vassileva J; Gonzalez R; Bechara A; Martin EM. Are all drug addicts impulsive? Effects of antisociality and extent of multidrug use on cognitive and motor impulsivity. Addictive Behaviors 32(12): 3071-3076, 2007. (14 refs.)

The purpose of this investigation was to examine the influence of antisociality and extent of multidrug use on cognitive and motor impulsivity among substance-dependent individuals (SDIs) that used primarily cocaine and/or heroin. One hundred currently abstinent male SDIs participated in the study. Extent of multidrug use and degree of antisociality, assessed with the Socialization Scale of the Califoria Psychological Inventory (So-CPI), were used to classify participants into one of four groups: high antisocial/low multidrug use, high antisocial/high multidrug use, low antisocial/low multidrug use, and low antisocial/high multidrug use. All subjects completed the Iowa Gambling Task to assess cognitive impulsivity and the Stroop Task to measure motor impulsivity. Contrary to expectations, antisociality was associated with more advantageous performance on the Iowa Gambling Task, independent of extent of multidrug use. In contrast, greater multidrug use was associated with general psychomotor slowing on the Stroop Task. Results suggest that a subclinical form of antisociality may have a paradoxically facilitating effect on decision-making and cognitive impulsivity among SDIs.

Virkkunen M; Rissanen A; Naukkarinen H; Franssila-Kallunki A; Linnoila M; Tiihonen J. Energy substrate: Metabolism among habitually violent alcoholic offenders having antisocial personality disorder. Psychiatric Research 150(3): 287-295, 2007. (44 refs.)

A large proportion of violent offences in Western countries are attributable to antisocial personality disorder (APD). Several studies have shown abnormal lipid, carbohydrate and low cerebrospinal fluid (CSF) monoamine metabolite levels in habitually violent alcoholic offenders with APD, but it is not clear how these biochemical abnormalities are related to each other in this disorder. We aimed to study energy substrate metabolism among habitually violent offenders with APD. Insulin sensitivity (euglycemic insulin clamp), basal energy expenditure (indirect calorimetry), and CSF 5-hydroxyindoleacetic acid (5-HIAA) measurements were performed on 96 habitually violent antisocial male alcoholic offenders and on 40 normal male controls. Habitually violent, incarcerated offenders with APD had significantly lower non-oxidative glucose metabolism, basal glucagon, and free fatty acids when compared with normal controls, but glucose oxidation and CSF 5-HIAA did not differ markedly between these groups. The effect sizes for lower non-oxidative glucose metabolism among incarcerated and non-incarcerated APD subjects were 0.73 and 0.51, respectively, when compared with controls, indicating that this finding was not explained by incarceration. Habitually violent offenders with APD have markedly lower glucagon and non-oxidative glucose metabolism when compared with healthy controls, and these findings were more strongly associated with habitual violent offending than low CSF 5-HIAA levels, a well-established marker for impulsive violent behavior. Follow-up studies are needed to confirm if abnormal glucose and lipid metabolism can be used to predict violent offending over the course of the APD offender's life span.

Walsh Z; Allen LC; Kosson DS. Beyond social deviance: Substance use disorders and the dimensions of psychopathy. Journal of Personality Disorders 21(3): 273-288, 2007. (45 refs.)

High rates of comorbidity between psychopathy and substance use disorders (SUD) have long been recognized. However, the extent to which relationships between SUD and psychopathy extends beyond shared relationship with general antisociality remains undetermined. We examined zero-order and unique relationships between the elements of psychopathy and four categories of SUD; alcohol, cannabis, cocaine, and opioid dependence. The sample consisted of 399 European American and African American male county jail inmates. The relationship between psychopathy and SUD extended beyond general antisociality to core features of the psychopathic personality. Relationships were relatively stable across ethnicity but were more generalized across SUD categories for European American inmates. The relationship between SUD and impulsive and irresponsible behavior was most consistent across categories of SUD; relationships with other elements of psychopathy varied according to category of SUD.

Wanner B; Vitaro F; Ladouceur R; Brendgen M; Tremblay RE. Joint trajectories of gambling, alcohol and marijuana use during adolescence: A person- and variable-centered developmental approach. Addictive Behaviors 31(4): 566-580, 2006. (32 refs.)

The usefulness of Moffitt's (1993) [Moffitt, T. E. (1993). Adolescence-limited and life-course-persistent antisocial behavior: A developmental taxonomy. Psychological Review, 100, 674-701.] theory of antisocial behavior was examined regarding gambling, alcohol and marijuana use. We assessed 903 Caucasian boys' developmental trajectories of these behaviors annually from age 11 through age 16. Severity of problems with these behaviors were assessed at ages 17 and 23. As correlates of these behaviors, teacher-rated personality and self-reported parenting were assessed at age 10. Self-reported autonomy was measured at ages 11 and 14. A cluster analysis on the correlates yielded two clusters. Membership in the cluster without adult problems was associated with either late onset of gambling and/or alcohol use trajectories or consistently low involvement in each of the behaviors. This cluster may correspond to Moffitt's adolescence-limited group and uninvolved adolescents, respectively. Membership in the cluster with subsequent adult problems was associated with early initiation of at least one of the three behaviors and involvement in each of them during adolescence. This cluster may correspond to Moffitt's life-course-persistent group. Findings indicate that early assessment of correlates used in the cluster analysis may be useful for screening and preventive purposes.

Westermeyer J; Thuras P; Carlson G. Association of antisocial personality disorder with psychiatric morbidity among patients with substance use disorder. Substance Abuse 26(2): 15-24, 2006

Objectives: The aims were to determine among patients with Substance Use Disorder (SUD) whether patients with Antisocial Personality Disorder (ASPD) manifest less, the same, or more of the following: (1) psychiatric symptoms, (2) family history of psychiatric disorder, (3) psychiatric disorders and morbidity, and (4) psychiatric treatment, as compared to patients without ASPD. Design &Definition: Scheduled interview using DSM-III-R criteria for ASPD, with blinded interviewers making the ASPD classification vs. other assessments. Settings: Alcohol-drug treatment programs located in two university medical centers. Subjects: Six hundred and six voluntary patients aged 18 and older meeting diagnostic criteria for SUD. Results: SUD patients with ASPD reported more family history of non-SUD psychiatric diagnoses and endorsed more hostility symptoms. Demographic characteristics, psychiatric disorder, and past psychiatric treatment did not differ in association with ASPD.

Woodall WG; Delaney HD; Kunitz SJ; Westerberg VS; Zhao HW. A randomized trial of a DWI intervention program for first offenders: Intervention outcomes and interactions with antisocial personality disorder among a primarily American-Indian sample. Alcoholism: Clinical and Experimental Research 31(6): 974-987, 2007. (51 refs.)

Background: Randomized trial evidence on the effectiveness of incarceration and treatment of first-time driving while intoxicated (DWI) offenders who are primarily American Indian has yet to be reported in the literature on DWI prevention. Further, research has confirmed the association of antisocial personality disorder (ASPD) with problems with alcohol including DWI. Methods: A randomized clinical trial was conducted, in conjunction with 28 days of incarceration, of a treatment program incorporating motivational interviewing principles for first-time DWI offenders. The sample of 305 offenders including 52 diagnosed as ASPD by the Diagnostic Interview Schedule were assessed before assignment to conditions and at 6, 12, and 24 months after discharge. Self-reported frequency of drinking and driving as well as various measures of drinking over the preceding 90 days were available at all assessments for 244 participants. Further, DWI rearrest data for 274 participants were available for analysis. Results: Participants randomized to receive the first offender incarceration and treatment program reported greater reductions in alcohol consumption from baseline levels when compared with participants who were only incarcerated. Antisocial personality disorder participants reported heavier and more frequent drinking but showed significantly greater declines in drinking from intake to posttreatment assessments. Further, the treatment resulted in larger effects relative to the control on ASPD than non-ASPD participants. Conclusions: Nonconfrontational treatment may significantly enhance outcomes for DWI offenders with ASPD when delivered in an incarcerated setting, and in the present study, such effects were found in a primarily American-Indian sample.

Wu LT; Howard MO. Psychiatric disorders in inhalant users: Results from the National Epidemiologic Survey on Alcohol and related Conditions. Drug and Alcohol Dependence 88(2/3): 146-155, 2007. (43 refs.)

Objective: To examine the prevalence and correlates of mood, anxiety, and personality disorders among lifetime inhalant users. Methods: Statistical analyses were based on data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative survey of adults in the United States. Results: Inhalant users (N = 664) had high lifetime prevalences of DSM-IV mood (48%), anxiety (36%), and personality (45%) disorders. Of all inhalant users, 70% met criteria for at least one lifetime mood, anxiety, or personality disorder and 38% experienced a mood or anxiety disorder in the past year. Prevalences of comorbid psychiatric disorders varied by gender. Compared with male inhalant users, female inhalant users had higher prevalences of lifetime dysthymia (24% versus 16%), any anxiety disorder (53% versus 30%), panic disorder without agoraphobia (25% versus 11%), and specific phobia (28% versus 14%), but a lower prevalence of antisocial personality disorder (22% versus 36%). Female inhalant users also were more likely than male inhalant users to meet criteria for three or more mood or anxiety disorders (15% versus 8%) in the past year. Among inhalant users with comorbid disorders, those who developed social or specific phobia typically experienced onset of these disorders prior to initiation of inhalant use; all other mood and anxiety disorders usually developed following the onset of inhalant use. Inhalant users who were women, poor, less educated, with early onset of inhalant use, family histories of psychopathology, and personal histories of substance abuse treatment had increased odds of psychiatric disorders. Conclusions: Psychiatric disorders are highly prevalent among inhalant users nationally and female inhalant users are more likely than male inhalant users to experience multiple psychiatric disorders. Inhalant use and its consequences among females warrant greater research attention.

Young R; Sweeting H; West P. A longitudinal study of alcohol use and antisocial behaviour in young people. Alcohol and Alcoholism 43(2): 204-214, 2008. (58 refs.)

Aims: To examine the direction of causation between young peoples antisocial behaviour and alcohol (mis)use in the longer and shorter term, together with their joint effects on alcohol-related trouble. Methods: A longitudinal study (2586 pupils) supplied data, allowing exploration of the causal effects of alcohol (mis)use and antisocial behaviour between ages 11 and 15, using structural equation models of longer and shorter-term relationships and joint-effects models in respect of alcohol-related trouble at age 15. This method allowed us to evaluate which of three hypotheses, described as disinhibition [alcohol (mis)use causes or facilitates antisocial behaviour], susceptibility [antisocial behaviour causes alcohol (mis)use] or reciprocal [alcohol (mis)use causes antisocial behaviour and the reverse] receives most support, both overall and by gender, social class, and drinking context. Results: Overall, the results support the susceptibility hypothesis, particularly in the longer-term models. There is no support for pure disinhibition. However, in the shorter-term and joint-effects models (i.e. as the time lag becomes shorter), there is evidence that in some gender, social class, or drinking contexts, in addition to antisocial behaviour causing alcohol (mis)use, the reverse also applies. Conclusions: Antisocial behaviour is the main predictor of alcohol (mis)use and alcohol-related trouble, with alcohol (mis)use impacting only modestly on antisocial behaviour and alcohol-related trouble in the shorter term.