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CORK Bibliography: Substance Abuse and Personality Disorders

76 citations. January 2009 to present

Prepared: September 2011

Ball SA; Maccarelli LM; LaPaglia DM; Ostrowski MJ. Randomized trial of dual-focused vs. single-focused individual therapy for personality disorders and substance dependence. Journal of Nervous and Mental Disease 199(5): 319- 328, 2011. (68 refs.)

We conducted a randomized comparison of dual-focus schema therapy with individual drug counseling as enhancements to the residential treatment of 105 substance-dependent patients with specific personality disorders versus those without. Both therapies were manual-guided and delivered for 6 months by experienced psychotherapists intensively trained and supervised with independent fidelity assessment. Using the Cox proportional hazards model, we found no psychotherapy differences in retention (days in treatment). Hierarchical linear modeling indicated that participants with personality disorders started with higher psychiatric, interpersonal, and dysphoria symptoms and that both therapies reduced symptoms in 6 months. Contrary to predictions, individual drug counseling resulted in more sustained reductions than did dual-focus schema therapy in several symptoms for several personality disorders. Our findings raised important questions about the added value of integrative or dual-focus therapies for co-occurring personality disorders and substance dependence relative to empirically supported therapies focused more specifically on addiction symptoms.

Becker DF; Anez LM; Paris M; Bedregal L; Grilo CM. Factor structure and diagnostic efficiency of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for avoidant personality disorder in Hispanic men and women with substance use disorders. Comprehensive Psychiatry 50(5): 463-470, 2009. (80 refs.)

Objective: This study examined the internal consistency, factor structure, and diagnostic efficiency of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), criteria for avoidant personality disorder (AVPD) and the extent to which these metrics may be affected by sex. Method: Subjects were 130 monolingual Hispanic adults (90 men, 40 women) who had been admitted to a specialty clinic that provides psychiatric and substance abuse services to Spanish-speaking patients. All were reliably assessed with the Spanish-Language Version of the Diagnostic Interview for DSM-IV Personality Disorders. The AVPD diagnosis was determined by the best-estimate method. After evaluating internal consistency of the AVPD criterion set, an exploratory factor analysis was performed using principal components extraction. Afterward, diagnostic efficiency indices were calculated for all AVPD criteria. Subsequent analyses examined men and women separately. Results: For the overall group, internal consistency of AVPD criteria was good. Exploratory factor analysis revealed a 1-factor solution (accounting for 70% of the variance), supporting the unidimensionality of the AVPD criterion set. The best inclusion criterion was "reluctance to take risks," whereas "interpersonally inhibited" was the best exclusion criterion and the best predictor overall. When men and women were examined separately, similar results were obtained for both internal consistency and factor structure, with slight variations noted between sexes in the patterning of diagnostic efficiency indices. Conclusions: These psychometric findings, which were similar for men and women, support the construct validity of the DSM-IV criteria for AVPD and may also have implications for the treatment of this particular clinical population.

Blanco C; Alegria AA; Petry NM; Grant JE; Simpson HB; Liu SM et al. Prevalence and correlates of fire-setting in the United States: Results From the National Epidemiology Survey on Alcohol and Related Conditions (NESARC). Journal of Clinical Psychiatry 71(9): 1218-1225, 2010. (45 refs.)

Objective: To estimate the prevalence, sociodemographic correlates, comorbidity, and rates of mental health service utilization of fire-setters in the general population. Method: A face-to-face survey of more than 43,000 adults aged 18 years and older residing in households was conducted during the 2001-2002 period. Diagnoses of mood, anxiety, substance use disorders, and personality disorders were based on the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version (AUDADIS-IV). Results: The prevalence of lifetime fire-setting in the US population was 1.13 (95% CI, 1.0-1.3). Being male, never married, and US-born and having a yearly income over $70,000 were risk factors for lifetime fire-setting, while being Asian or Hispanic and older than 30 years were protective factors for lifetime fire-setting. The strongest associations with fire-setting were with disorders often associated with deficits in impulse control, such as antisocial personality disorder (ASPD) (odds ratio [OR] = 21.8; CI, 6.6-28.5), drug dependence (OR = 7.6; 95% CI, 5.2-10.9), bipolar disorder (OR = 5.6; 95% CI, 4.0-7.9), and pathological gambling (OR = 4.8; 95% CI, 2.4-9.5). Associations between fire-setting and all antisocial behaviors were positive and significant. A lifetime history of fire-setting, even in the absence of an ASPD diagnosis, was strongly associated with substantial rates of Axis I comorbidity, a history of antisocial behavior, a family history of other antisocial behaviors, decreased functioning, and higher treatment-seeking rates. Conclusions: Our findings suggest that fire-setting may be better understood as a behavioral manifestation of a broader impaired control syndrome and part of the externalizing spectrum. Fire-setting and other antisocial behaviors tend to be strongly associated with each other and increase the risk of lifetime and current psychiatric disorders, even in the absence of a DSM-IV diagnosis of ASPD.

Bornovalova MA; Gratz KL; Levy R; Lejuez CW. Understanding the heterogeneity of BPD symptoms through latent class analysis: Initial results and clinical correlates among inner-city substance users. Psychological Assessment 22(2): 233-245, 2010. (75 refs.)

The current study investigated the heterogeneity of borderline personality disorder (BPD) symptoms in a sample of 382 inner-city, predominantly African American male substance users through the use of latent class analysis. A 4-class model was statistically preferred, with 1 class interpreted to be a baseline class. I class interpreted to be a high-BPD class, and 2 classes interpreted as intermediate classes. As a secondary goal, we examined the resulting BPD classes with respect to relevant clinical correlates, including temperamental vulnerabilities (affective instability, impulsivity, and interpersonal instability), childhood emotional abuse, drug choice, and co-occurring mood and anxiety disorders. The high-BPD class evidenced the highest levels of the temperamental vulnerabilities and environmental stressors. the baseline class evidenced the lowest levels, and the 2 intermediate classes fell in between. In addition, the high-BPD class had a higher probability of cocaine and alcohol dependence, as well as mood and anxiety disorders, than did the baseline class. Rates of alcohol use and mood disorders for the intermediate classes fell in between the high-BPD and the baseline classes. Results are discussed in relation to the current diagnostic conceptualization of BPD.

Brunelle C; Douglas RL; Pihl RO; Stewart SH. Personality and substance use disorders in female offenders: A matched controlled study. Personality and Individual Differences 46(4): 472-476, 2009. (42 refs.)

A number of personality traits have been investigated in relation to delinquent behaviour; however, the female offender population has received far less attention than male offenders. In the current study, 32 incarcerated female offenders, and 32 matched female controls were compared on a measure of behavioural activation and behavioural inhibition, as well as on the personality dimensions of hopelessness /introversion, anxiety sensitivity, impulsivity, and sensation seeking. Lifetime abuse and dependence on various psychoactive substances was also investigated. Stimulant abuse/dependence, impulsivity, and sensation seeking were significant independent predictors of incarceration status in a logistic regression analysis. A stimulant use disorder was a partial mediator of the relationship between sensation seeking and incarceration status. These results suggest that, similar to male populations, disinhibited personality traits and drug use are associated with criminal behaviour in women, and may be important targets for intervention.

Buu A; DiPiazza C; Wang J; Puttler LI; Fitzgerald HE; Zucker RA. Parent, family, and neighborhood effects on the development of child substance use and other psychopathology from preschool to the start of adulthood. Journal of Studies on Alcohol and Drugs 70(4): 489-498, 2009. (37 refs.)

Objective: We examined the long-term effects of childhood familial and neighborhood risk on adolescent substance use and psychiatric symptomatology. Method: This study used data from an ongoing 2-decade long study that recruited alcoholic and neighborhood control families through fathers' drunk-driving records and door-to-door canvassing in a four county area. The sample included 220 male, initially 3- to 5-year-old children of the participant families, who received in-home assessments at baseline and thereafter at 3-year intervals. Parental lifetime psychopathology and offspring symptomatology at ages 18-20 were assessed by semistructured diagnostic interviews. Census tract variables were used to indicate neighborhood characteristics. Results: The isomorphic parental symptomatology predicted offspring psychopathology. For marijuana-use disorder, major depressive disorder, and nicotine dependence, the other parental comorbidities were also significant predictors. Neighborhood residential instability in childhood contributed to the development of late adolescent alcohol-use disorder, marijuana-use disorder, major depressive disorder, antisocial personality disorder, and nicotine-dependence symptomatology Although lower family socioeconomic status in childhood contributed to more adolescent marijuana-use disorder, major depressive disorder, and nicotine-dependence symptoms, neighborhood socioeconomic status did not predict adolescent psychopathology. Longitudinal changes in neighborhood environments from early childhood to adolescence had significant effects on alcohol-use disorder, marijuana-use disorder, and major depressive disorder symptoms in late adolescence. A higher frequency of family mobility from early childhood to adolescence predicted more nicotine-dependence symptoms in late adolescence. Conclusions: Findings indicate that parental psychopathology, family socioeconomic status, and neighborhood residential instability are all important risk factors for the development of substance-use disorder and other comorbid psychopathology. Intervention programming might effectively use these early parental psychopathology indicators to identify risk and might target community activity to stabilize the social environment and provide youth services to counteract the effects of family transience.

Carpentier PJ; Krabbe PFM; van Gogh MT; Knapen LJM; Buitelaar JK; de Jong CAJ. Psychiatric comorbidity reduces quality of life in chronic methadone maintained patients. American Journal on Addictions 18(6): 470-480, 2009. (72 refs.)

Despite the efficacy of methadone maintenance treatment (MMT), opioid dependence still involves severe impairment of functioning and low quality of life. This study examines the influence of the psychiatric comorbidity of MMT patients on their quality of life. A total of 193 middle-aged patients in long-term MMT were assessed for current and lifetime Axis I psychiatric disorders, substance use disorders, and personality disorders using the MINI, the CIDI-SAM, and the SIDP-IV. Quality of life (Qol) was assessed using the EQ-5D. Psychiatric comorbidity was documented in 78% of the patients. Mood disorders (60%) and anxiety disorders (46%) were the most common diagnoses. Additional substance use disorders were diagnosed in 70% of the MMT patients. While a probable personality disorder was documented for 65% of the patients, 66 of these patients actually showed an antisocial personality disorder. Qol was severely diminished to a level comparable to that for patients with chronic psychiatric and/or somatic disorders. Multivariate analyses showed the occurrence of comorbid psychiatric disorders to explain about 32% of the variance in Qol. The quality of life for MMT patients is generally low. The present results showed a high rate of psychiatric comorbidity for this patient group with mood disorders, additional substance use disorders, and personality disorders occurring in particular. Such comorbid psychopathology substantially affects quality of life. The negative influence of comorbid psychopathology on quality of life is an important reason to provide additional mental health services for MMT patients.

Chakroun N; Johnson EI; Swendsen J. Mood and personality-based models of substance use. Psychology of Addictive Behaviors 24(1): 129-136, 2010. (46 refs.)

Mood and personality-based vulnerabilities have been extensively examined in patients with substance use disorders, but their relevance as models of etiology remains to be fully investigated. The present investigation examined mood and personality-based models of substance use in a nonclinical sample of young adults. Two-hundred and twelve individuals were assessed for personality and clinical characteristics and participated in computerized ambulatory monitoring of mood states and substance use over a I-week period. Personality factors were strong predictors of substance use frequency over the previous 30 days, as well as of substance use in daily life using ambulatory monitoring. A linear increase was also observed in the intensity of novelty seeking and antisocial personality traits as a function of the social deviance of substances used. However, mood disorder history was related only to the use of illicit drugs other than cannabis, and fluctuations in mood states did not prospectively predict daily use of substances in a manner consistent with self-medication. Moreover, there was little evidence that personality characteristics moderated relations between mood states and substance use in daily life. The relevance of results for mood and personality models of substance use etiology is discussed.

Charney DA; Zikos E; Gill KJ. Early recovery from alcohol dependence: Factors that promote or impede abstinence. Journal of Substance Abuse Treatment 38(1): 42-50, 2010. (62 refs.)

The objectives of this prospective follow-up study were to identify factors that promote or impede the early recovery process and to examine whether drinking status at 4 weeks predicts later abstinence. Patients with alcohol use disorders were assessed by clinical and semistructured interviews upon entering addiction treatment (N = 175) and were followed up biweekly to monitor their alcohol use. During the first 4 weeks of treatment, 57% (n = 100) of patients slipped or relapsed on alcohol, whereas 43% (n = 75) were fully abstinent. Patients who slipped or relapsed were more likely to report nondependent use of a secondary substance, meet criteria for a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis II Cluster B personality disorder, have a higher level of impulsivity, and have more severe social problems at intake. The final logistic regression model accounted for 37% of the variance in drinking status. Patients who slipped or relapsed early in treatment were likely to continue to struggle to maintain abstinence at 12 weeks.

Conroy S; Marks MN; Schacht R; Davies HA; Moran PA. Maternal personality disorder and babies' exposure to tobacco smoke. Archives of Women's Mental Health 13(5): 439-442, 2010. (20 refs.)

This study examined the association between smoking practices and maternal personality disorder in a sample of 200 mothers of 2-month-old babies. Maternal personality disorder was robustly associated with allowing smoking in the home and also exposing the baby to tobacco smoke. The findings suggest that mothers with personality disorders might particularly benefit from targeting with education and advice about reducing their baby's exposure to environmental tobacco smoke in the postpartum period.

Courbasson C; Brunshaw JM. The relationship between concurrent substance use disorders and eating disorders with personality disorders. International Journal of Environmental Research and Public Health 6(7): 2076-2089, 2009. (53 refs.)

Objective: The current pilot study investigated whether patients with concurrent substance use disorders and eating disorders (SUD and ED) who experienced a reduction in SUD and ED symptoms following treatment for SUD and ED also experienced a reduction in personality disorder (PD) symptoms. Method: Twenty patients with SUD and ED and PD were assessed pre and post treatment using clinical interviews, self-report questionnaires, and a therapist questionnaire on DSM-IV-TR symptoms for PD. Results: Symptoms for the personality disorders were reduced following treatment. This reduction was correlated with a decrease in the number of symptoms of ED at post treatment. Discussion: Chronic concurrent SUD and ED may make it difficult to separate PD symptoms from co-occurring disorders. Many features attributed to PDs may be reduced when problematic substance use and disordered eating are addressed, a fact that may increase clinician and patients' optimism about therapeutic change.

Darke S; Torok M; McKetin R; Kaye S; Ross J. Patterns of psychological distress related to regular methamphetamine and opioid use. Addiction Research & Theory 19(2): 121-127, 2011. (31 refs.)

In order to determine the independent associations of methamphetamine and heroin use to global psychological distress, symptom patterns and personality disorder, 400 regular users of these drugs were administered the Brief Symptom Inventory. The mean global severity score was 2.39 standard deviations above the population norm, and 24% were classified as cases. After controlling for potential confounders, higher levels of global psychological distress were independently associated with more frequent use of both drug classes. Depression was associated with the frequency of heroin use, but not with methamphetamine use. Phobic anxiety, interpersonal sensitivity and psychoticism were independently related to the frequency of methamphetamine use, but not to heroin use. Neither methamphetamine nor heroin use were independent correlates of a diagnosis of borderline personality disorder or conduct disorder. Whilst higher levels of psychological distress were associated with both methamphetamine and heroin use, symptom patterns were differentially related to the use of these drugs.

Davidson KM; Tyrer P; Tata P; Cooke D; Gumley A; Ford I. Cognitive behaviour therapy for violent men with antisocial personality disorder in the community: an exploratory randomized controlled trial. Psychological Medicine 39(4): 569-577, 2009. (29 refs.)

Background. Little information exists on treatment effectiveness in antisocial personality disorder (ASPD). We investigated the feasibility and effectiveness of carrying out a randomized controlled trial of cognitive behaviour therapy (CBT) in men with ASPD who were aggressive. Method. This was an exploratory two-centre, randomized controlled trial in a community setting. Fifty-two adult men with a diagnosis of ASPD, with acts of aggression in the 6 months prior to the study, were randomized to either treatment as usual (TAU) plus CBT, or usual treatment alone. Change over 12 months of follow-up was assessed in the occurrence of any act of aggression and also in terms of alcohol misuse, mental state, beliefs and social functioning. Results. The follow-up rate was 79%. At 12 months, both groups reported a decrease in the occurrence of any acts of verbal or physical aggression. Trends in the data, in favour of CBT, were noted for problematic drinking, social functioning and beliefs about others. Conclusions. CBT did not improve outcomes more than usual treatment for men with ASPD who are aggressive and living in the community in this exploratory study. However, the data suggest that a larger study is required to fully assess the effectiveness of CBT in reducing aggression, alcohol misuse and improving social functioning and view of others. It is feasible to carry out a rigorous randomized controlled trial in this group.

De Genna NM; Feske U; Angiolieri T; Gold MA. Race and sexually transmitted diseases in women with and without borderline personality disorder. Journal of Women's Health 20(3): 333-340, 2011. (49 refs.)

Background: The purpose of this study was to examine the history of sexually transmitted diseases (STDs) among women with borderline personality disorder (BPD) with and without a lifetime substance use disorder (SUD) and to compare their histories to those of a group of women with a current nonpsychotic axis I disorder. Methods: Two-hundred fifteen women completed the Structured Clinical Interview for DSM-IV Axis I diagnoses (SCID-I), Structured Interview for DSM-IV Personality for Axis II diagnoses (SIDP-IV), and a sexual health interview. African American women were oversampled because little is known about BPD in African American women and because they are at greater risk for STDs than non-African American women. Results: Women with a lifetime SUD (especially cannabis use disorder) reported more STD risk factors and STDs than women without a lifetime SUD. BPD dimensional scores and African American race were predictors of STD, even after controlling for age, socioeconomic status (SES), SUDs, and participation in the sex trade. Conclusions: Determining predictors of STDs within at-risk subpopulations may help reduce the spread of STDs and prevent HIV infection within these groups by helping providers identify women at the highest risk of infection.

del Rio EF; Lopez A; Becona E. Personality disorders and premature dropout from psychological treatment for smoking cessation. Psychological Reports 106(3): 679-684, 2010. (27 refs.)

The relation between personality disorders and premature dropout (attending half of the sessions or fewer) from a psychological treatment for giving up smoking was examined in a sample of 202 smokers. Percent of premature dropout was significantly higher for smokers with personality disorder in general, specifically for smokers with dependent personality disorder and with Cluster C personality disorder, than in smokers without such psychopathology.

del Rio EF; Lopez A; Becona E. Smoking cessation: Case study of a client with probable borderline personality disorder. Psychological Reports 106(3): 918-926, 2010. (47 refs.)

This report concerns the case of a female client with a probable borderline personality disorder who requested psychological treatment for the cessation of smoking. After six sessions, this client gave up smoking and remained abstinent at follow-up after 1, 3, 6, and 12 months. The presence of a probable borderline personality disorder did not interfere in the cessation of tobacco use or in the maintenance of abstinence.

Ducci F; Enoch MA; Yuan Q; Shen PH; White KV; Hodgkinson C et al. HTR3B is associated with alcoholism with antisocial behavior and alpha EEG power -- an intermediate phenotype for alcoholism and co-morbid behaviors. Alcohol 43(1): 73-84, 2009. (54 refs.)

Alcohol use disorders (AUD) with co-morbid antisocial personality disorder (ASPD) have been associated with serotonin (5-HT) dysfunction. 5-HT3 receptors are potentiated by ethanol and appear to modulate reward. 5-HT3 receptor antagonists may be useful in the treatment of early-onset alcoholics with co-morbid ASPD. Low-voltage alpha electroencephalogram (EEG) power, a highly heritable trait, has been associated with both AUD and ASPD. A recent whole genome linkage scan in one of our samples, Plains American Indians (PI), has shown a suggestive linkage peak for alpha power at the 5-HT3R locus. We tested whether genetic variation within the HTR3A and HTR3B genes influences vulnerability to AUD with comorbid ASPD (AUD + ASPD) and moderates alpha power. Our study included three samples: 284 criminal alcoholic Finnish Caucasians and 234 controls; two independent community-ascertained samples with resting EEG recordings: a predominantly Caucasian sample of 191 individuals (Bethesda) and 306 PI. In the Finns, an intronic HTR3B SNP rs3782025 was associated with AUD + ASPD (P = .004). In the Bethesda sample, the same allele predicted lower alpha power (P = 7.37e(-5)). Associations between alpha power and two other HTR3B SNPs were also observed among PI (P = .03). One haplotype in the haplotype block at the 3' region of the gene that included rs3782025 was associated with AUD + ASPD in the Finns (P = .02) and with reduced alpha power in the Bethesda population (P = .00009). Another haplotype in this block was associated with alpha power among PI (P = .03). No associations were found for HTR3A. Genetic variation within HTR3B may influence vulnerability to develop AUD with comorbid ASPI). 5-HT3R might contribute to the imbalance between excitation and inhibition that characterize the brain of alcoholics.

Echeburua E; De Medina RB; Aizpiri J. Personality disorders among alcohol-dependent patients manifesting or not manifesting cocaine abuse: A comparative pilot study. Substance Use & Misuse 44(7): 981-989, 2009. (25 refs.)

This study assessed personality disorders (PDs) in 158 alcohol-dependent outpatients (62 manifesting cocaine abuse and 96 without cocaine abuse) with the International Personality Disorders Examination interview between 2003 and 2006. Thirty-nine alcohol-dependent/cocaine abusers (62.9% of this group) and 51 only alcohol-dependent patients (53.1% of this group) manifested at least one PD. There were no statistically significant differences between groups in the overall prevalence rate of PDs. The most prevalent PDs, among the alcohol-dependent/cocaine abusers, were antisocial (21%), narcissistic (14.5%), and borderline (11.3%) PDs. The most frequently diagnosed PDs among the only alcohol-dependent patients were obsessive-compulsive (20.8%), paranoid (10.4%), and dependent (9.4%) PDs. There were significant differences between the groups. The study limitations arc discussed.

Flensborg-Madsen T; Mortensen EL; Knop J; Becker U; Sher L; Gronbaek M. Comorbidity and temporal ordering of alcohol use disorders and other psychiatric disorders: Results from a Danish register-based study. Comprehensive Psychiatry 50(4): 307-314, 2009. (56 refs.)

Background: Understanding the comorbidity of alcohol use disorders (AUD) and other psychiatric disorders may have important implications for treatment and preventive interventions. However, information on the epidemiology of this comorbidity is lacking. The objective of this study was to present results on lifetime psychiatric comorbidity of AUD in a large Danish community population. Methods: A prospective cohort study was used, comprising 3 updated measures of sets of lifestyle covariates and 26 years of follow-up data on 18 146 individuals from the Copenhagen City Heart Study, Denmark. The study population was linked to national Danish hospital registers and a greater Copenhagen alcohol unit treatment register to detect registrations with AUD and other psychiatric disorders. Results: Personality disorders were the most common comorbid disorders (24%)) together with mood disorders (16.8%) and drug abuse (16.6%). The risk of developing a psychiatric disorder in individuals who were already registered with AUD was larger than the risk of developing AUD in individuals who were already registered with another psychiatric disorder; these differences in risk were especially noticeable for anxiety disorders, personality disorders and drug abuse. Conclusions: AUD is frequently comorbid with other psychiatric disorders, and it is likely that AUD is both an etiologic factor in other mental disorders and a consequence of mental disease. However, in interpreting these complex and perhaps circular causal links. it is important to consider that AUD is registered before a comorbid psychiatric diagnosis snore often than the reverse temporal order.

Ford JD; Gelernter J; Devoe JS; Zhang W; Weiss RD; Brady K et al. Association of psychiatric and substance use disorder comorbidity with cocaine dependence severity and treatment utilization in cocaine-dependent individuals. Drug and Alcohol Dependence 99(1-3): 193-203, 2009. (74 refs.)

The relations among psychiatric and substance dependence disorders and treatment utilization are of interest both for their clinical management and for health services. We examined these relations using six self-reported indices of cocaine dependence severity and three self-reported measures of treatment utilization and self-help group participation for cocaine dependence. The sample consisted of dyads: namely, a cocaine-dependent adult proband (N=449) and a cocaine-dependent sibling (N=449). Psychiatric and substance use disorders were assessed with the semi-structured Assessment for Drug Dependence and Alcoholism. We controlled for the nesting within families of proband-sibling dyads and for demographic features using generalized estimating equation linear and logistic regression analyses. We found that psychiatric disorders were associated with an increased likelihood of cocaine dependence treatment or self-help group participation, but with only one of six indices of cocaine dependence severity. Bipolar disorder and antisocial personality disorder were associated with greater past heavy cocaine use, and with utilizing self-help but not treatment. Major depressive disorder and posttraumatic stress disorder were associated with treatment utilization and overall services utilization, respectively. The presence of other substance use disorders (SUDs) was the strongest correlate of cocaine dependence severity. Results suggest that co-occurring substance dependence and psychiatric disorders warrant attention in cocaine dependence assessment, treatment, and self-help.

Gahr M; Freudenmann R; Schonfeldt-Lecuona C. Non-suicidal self-injury by intravenous application of nicotine in a patient with borderline personality disorder resulting in substance dependence. Addiction 106(6): 1186- 1187, 2011. (4 refs.)

Background: Non-suicidal self-injury in many different forms is a classic struggle for those diagnosed with borderline personality disorder (BPD). Some common ways of NSSI are cutting, scratching and head-banging. Case description: A 23-year old woman with BPD presented in our clinic with a 4-month history of intravenous application of a liquid dosage form of nicotine that is generally used for nasal application. Accordingly, the patient developed nicotine dependency (ICD-10 F17.25). Before her admission to our ward the daily intravenous nicotine application was around 33 mg. The in-patient detoxification proceeded without a remarkable withdrawal syndrome. Conclusion: A case of regular intravenous administration of nicotine has been observed, apparently resulting in nicotine dependence in a person with borderline personality disorder. The original intent appears to have been self-harm.

Gibbie TM; Hides LM; Cotton SM; Lubman DI; Aitken C; Hellard M. The relationship between personality disorders and mental health, substance use severity and quality of life among injecting drug users. Medical Journal of Australia 195(3, supplement): S16-S21, 2011. (21 refs.)

Objective: To determine the relationship between personality disorders (PDs) and substance use severity, mental health symptoms and disorders and quality of life (QoL) among injecting drug users (IDUs). Design, setting and participants: A cross-sectional study of 103 IDUs accessing a needle and syringe program and a primary health centre in Melbourne, Australia. Main outcome measures: Presence of PDs was assessed using the International Personality Disorder Examination ICD-10 Screener. Axis I mental health disorders, psychological distress and QoL were also assessed. Results: Ninety per cent of participants scored positive for one or more PD. Having a Cluster A or Cluster B PD was associated with greater severity of substance use. The. presence of a current mental health disorder was associated with all types of PD except dissocial PD. Only Cluster C PDs were associated with self-reported levels of psychological distress. Cluster C PDs were more strongly associated with substance use, mental health and QoL variables than Cluster A or B, although the number of PDs present had the strongest associations with these variables. Conclusions: IDUs had high rates of PD symptoms, which were associated with the presence of concurrent mental health disorders, more severe levels of psychological distress and substance use and low perceived QoL. IDUs require comprehensive models of care, including access to mental-health practitioners with expertise in co-occurring disorders.

Goodman M; Patil U; Steffel L; Avedon J; Sasso S; Triebwasser J et al. Treatment utilization by gender in patients with Borderline Personality Disorder. Journal of Psychiatric Practice 16(3): 155-163, 2010. (33 refs.)

Minimal data exist on treatment utilization by gender in borderline personality disorder (BPD). This study used an online questionnaire to investigate initial and lifetime patterns of utilization of multiple treatment modalities by patients with BPD, and parental satisfaction with treatment. Respondents were parents of probands diagnosed with BPD who completed a 100-question anonymous Internet survey. Of the 495 surveys that were analyzed, 409 pertained to female subjects with BPD and 86 to male subjects with BPD. Results for probands with BPD across gender were notable for similar high lifetime levels of use of care, including hospitalization, day programs, and halfway houses, but not similar levels of use of drug/alcohol rehabilitation services, which was greater among the male subjects with BPD. The male subjects with BPD received significantly less lifetime psychotherapy and pharmacotherapy than the female subjects with BPD, although the duration of medication and psychotherapy treatment did not differ by gender. These results highlight the need for more research to better understand what might account for these gender differences in treatment and improve strategies to provide appropriate care for male patients with BPD.

Grella CE; Karno MP; Warda US; Niv N; Moore AA. Gender and comorbidity among individuals with opioid use disorders in the NESARC study. Addictive Behaviors 34(6-7): 498-504, 2009. (59 refs.)

This study examines gender differences in the association of lifetime mental and substance use disorders among individuals with opioid use disorders in the United States. The sample (N = 578) is from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), which is a representative household survey. Bivariate analyses and logistic regression modeling were conducted. About 70% of the sample had a lifetime non-substance use Axis I disorder; women were about twice as likely as men to have either a mood or anxiety disorder. About half of the sample had a personality disorder, with women more likely to have paranoid disorder and men more likely to have antisocial personality disorder. Individuals with a lifetime mental disorder were about three times more likely than others to be dependent on other substances, independent of gender. The study demonstrated an inverse relationship between lifetime mental and other substance use disorders, with women having significantly higher odds for several of the mental disorders and men having greater odds of other substance use disorders.

Gudonis LC; Derefinko K; Giancola PR. The treatment of substance misuse in psychopathic individuals: Why heterogeneity matters. Substance Use & Misuse 44(9/10, Special Issue): 1415-1433, 2009. (81 refs.)

Psychopathy is a personality syndrome characterized by egocentricity, grandiosity, remorselessness, callousness, impulsivity, and manipulativeness. It is also a disorder highly comorbid with substance use disorders (Derefinko and Lynam, 2007: Smith anti Newman, 1990; Tourian el at., 1997). However, unlike their other criminal counterparts, psychopaths' substance use related problems appear remarkably resilient despite treatment (Smith and Newman, 1990) leading many to conclude the dually diagnosed psychopathic substance misuser is "untreatable." However, this pessimistic stance is predicated upon the notion that psychopathy is a homogeneous, categorical construct. Such a conclusion leaves little hope for treating substance use problems in this population, and has certainly attenuated efforts at developing effective clinical interventions (Seto and Quinsey, 2006). In this review, we argue that conceptualizing psychopathy as a heterogeneous and dimensional construct reveals a common thread of negative emotionality (NEM) that may clarify the relations between psychopathy, and substance use disorders as well as pave the way for more practical and viable treatment options.

Hansen NB; Cavanaugh CE; Vaughan EL; Connell CM; Tate DC; Sikkema KJ et al. The influence of personality disorder indication, social support, and grief on alcohol and cocaine use among HIV-positive adults coping with AIDS-related bereavement. AIDS and Behavior 13(2): 375-384, 2009. (58 refs.)

Substance use is prevalent among HIV-positive adults and linked to a number of adverse health consequences; however little is known about risk and protective factors that influence substance use among HIV-positive adults coping with AIDS-related bereavement. Using structural equation modeling (SEM), male gender, diagnostic indications of antisocial and borderline personality disorders (PD), and grief severity were tested as risk factors, and social support as a protective factor, for alcohol and cocaine use among a diverse sample of 268 HIV-positive adults enrolled in an intervention for AIDS-related bereavement. Results indicated that the hypothesized model fit the study data. Male gender, PD indication, and social support had direct effects on substance use. PD had significant indirect effects on both alcohol and cocaine use, mediated by social support, but not by grief. Finally, both PD and social support had significant, but opposite, effects on grief. Implications for intervention and prevention efforts are discussed.

Hills AL; Afrfi TO; Cox BJ; Bienvenu J; Sareen J. Externalizing psychopathology and risk for suicide attempt: Cross-sectional and longitudinal findings from the Baltimore Epidemiologic Catchment Area Study. Journal of Nervous and Mental Disease 197(5): 293-297, 2009

The unique association between externalizing psychopathology (i.e., diagnoses of alcohol dependence, drug dependence, and antisocial personality disorder) and suicide attempts has been understudied. We sought to examine whether externalizing disorders were risk factors for later development of new onset suicide attempts. This study examined cross-sectional and longitudinal data gathered from 1920 to 4034 adult respondents from the Baltimore site of the Epidemiologic Catchment Area Survey. In cross-sectional analyses, externalizing psychopathology was significantly associated with suicide attempts, even after adjusting for sociodemographics and internalizing disorders. After controlling for demographics and internalizing disorders, at 1-year follow-up (n = 3163) baseline externalizing psychopathology was associated with new onset suicides; at 13-year follow-up (n = 1920) baseline extemalizing psychopathology was not associated with new onset suicide attempts. Externalizing psychopathology appears to be an independent short-term risk factor for suicidal behavior (odds ratio [OR] = 3.00; 95% confidence interval [CI] = 1.07-8.43), but appears less powerful in predicting long-term suicide risk (OR = 0.90; 95% CI = 0.25-3.18). These findings underline the importance of assessment of suicidality among individuals presenting with externalizing disorders.

Howard MO; Perron BE; Vaughn MG; Bender KA; Garland E. Inhalant use, inhalant-use disorders, and antisocial behavior: Findings: from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Journal of Studies on Alcohol and Drugs 71(2): 201-209, 2010. (21 refs.)

Objective: Few studies have explored the topography of antisocial behavior in a nationally representative sample of inhalant users. We examined (a) the lifetime prevalence of 20 childhood and adult antisocial behaviors in inhalant users with inhalant-use disorders (IUD+) and without IUDs (IUD); (b) the nature and strength of associations between inhalant use, IUDs, and specific antisocial behaviors in multivariate analyses; and (c) the relationships between inhalant use, IUDs, and antisocial behaviors in a national sample of adults with antisocial personality disorder. Method: The National Epidemiologic Survey on Alcohol and Related Conditions was a multistage national survey of 43,093 U.S. residents. Respondents completed a structured psychiatric interview. Results: IUD+ and IUD respondents were significantly younger and more likely to be unemployed, to be male, to have never married, and to report family and personal histories of alcohol and drug problems than inhalant nonusers. Family histories of alcohol problems and personal histories of drug problems were significantly more prevalent among IUD+ respondents, compared with IUD respondents. In bivariate analyses, IUD+ and IUD respondents evidenced significantly higher lifetime levels of all childhood and adult antisocial behaviors than inhalant nonusers. IUD+ respondents were significantly more likely than their IUD counterparts to report bullying behavior, starting physical fights, using dangerous weapons, physical cruelty to people, staying out all night without permission, running away, and frequent truancy in childhood, as well as greater deceitfulness, impulsivity, irritability/aggressiveness, recklessness, and irresponsibility in adulthood. Multivariate analyses indicated that IUD+ respondents had a significantly elevated risk for childhood and adult antisocial behaviors, compared with inhalant nonusers, with the strongest effects for using dangerous weapons, physical cruelty to animals, and physical cruelty to people. Similarly, IUD+ respondents differed significantly from their IUD counterparts primarily across measures of interpersonal violence. Among persons with antisocial personality disorder, inhalant use and IUDs were associated with greater antisocial behavior, albeit with fewer and weaker effects. Conclusions: Respondents with IUDs had pervasively elevated levels of antisocial conduct, including diverse forms of early-onset and interpersonally violent behavior.

Ilgen MA; Price AM; Burnett-Zeigler I; Perron B; Islam K; Bohnert ASB et al. Longitudinal predictors of addictions treatment utilization in treatment-naive adults with alcohol use disorders. Drug and Alcohol Dependence 113(2-3): 215-221, 2011. (43 refs.)

Background: Despite the substantial prevalence of alcohol use disorders (AUDs), prior research indicates that most people with AUDs never utilize either formal or informal treatment services. Several prior studies have examined the characteristics of individuals with AUDs who receive treatment; however, limited longitudinal data are available on the predictors of receiving AUD services in treatment-naive individuals with AUDs. Methods: This study utilized data from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) to identify adults in Wave 1 who met criteria for an AUD within the last 12 months and reported no prior lifetime alcohol treatment (N = 2760). These individuals were surveyed again at Wave 2, approximately 3-4 years later (N = 2170). This study examined the Wave 1 demographic and psychiatric conditions that were associated with receipt of AUD treatment services between Waves 1 and 2. Results: In multivariable analyses, use of AUD treatment services between Waves 1 and 2 was significantly more likely among those who were male, non-Caucasian, younger, had lower income, and who had health insurance. Additionally, those who met criteria for a baseline drug use disorder, anxiety disorder or a personality disorder were more likely to receive AUD treatment. Conclusions: Treatment was more often utilized in those who had more severe baseline psychopathology and in those with fewer economic resources. These findings highlight the need to broaden the types of care available to individuals with AUDs to increase the appeal of AUD services.

Jansson I; Hesse M; Fridell M. Influence of personality disorder features on social functioning in substance-abusing women: Five years after compulsive residential treatment. European Addiction Research 15(1): 25-31, 2009. (21 refs.)

Background: Personality disorders (PD) are related to negative outcome in substance abuse treatment, and in the general population, personality disorders are related to negative outcome in overall functioning. Little is known about the impact of PD on adjustment following substance abuse treatment. Methods: A cohort of 132 women was followed for 5 years after their index treatment episode in compulsory treatment. During treatment, patients were assessed with the SCID-II. At follow-up, patients were administered a timeline follow-back interview covering their functioning, including employment status over the years, and linked with hospital and criminal justice registers. Results: The impact of PD on functioning varied substantially between disorders and outcome domains. Conduct disorder alone was associated with criminal justice involvement, and conduct disorder and avoidant PD features were associated with unemployment. Dependent PD and obsessive-compulsive personality disorder features were positively associated with employment. Borderline PD features were associated with hospital admissions. Discussion: We discuss how strategies associated with various PDs may foster or hinder social adjustment in general and employment patterns in particular.

Jariani M; Saaki M; Nazari H; Birjandi M. The effect of olanzapine and sertraline on personality disorder in patients with methadone maintenance therapy. Psychiatria Danubina 22(4): 544-547, 2010. (19 refs.)

Background: Various drugs have been suggested for treatment of Borderline Personality Disorder (BPD)-a disabling disease affecting two percent of the general population. If a drug could alleviate a wide range of symptoms, it would be more suitable. In these disorders drug addiction is very common. This fact makes the symptoms complicated and the treatment more difficult. Subjects and methods: This study is designed to evaluate the effect of Olanzapine and Sertraline in patients suffering from personality disorders who are on methadone maintenance therapy. This study is a clinical trial. 120 males and females were chosen for methadone maintenance therapy through interview by a psychiatrist based on DSM-IV-TR diagnostic criteria for BPD. Afterwards they were randomly divided into two groups. These groups separately received Olanzapine (5-10 mg daily) and Sertraline (50-100 mg daily) therapy. The SCL-90 questionnaire was filled by all participants before treatment and at the 4(th), 8(th) and 12(th) weeks of treatment. Results: According to this clinical trial, Olanzapine and Sertraline are effective in ameliorating symptoms of depression, anxiety and aggression, reducing sensitivity in interpersonal relationships and alleviating obsessive symptoms, pessimistic behaviors and somatization disorders in patients with personality disorders on methadone maintenance therapy. Conclusion: As result of this study it appears that Olanzapine and Sertraline are definitely effective in alleviating symptoms of patients with personality disorder, prescribing theses drugs are recommended for these patients.

Kieling RR; Szobot CM; Matte B; Coelho RS; Kieling C; Pechansky F et al. Mental disorders and delivery motorcycle drivers (motoboys): A dangerous association. European Psychiatry 26(1): 23-27, 2011. (32 refs.)

Objective. - Low and middle-income countries experience an expressive growth in the number of circulating motorcycles, paralleled by an increasing number of traffic accidents. Delivery motorcycles drivers ("motoboys") are generally perceived as accountable for this scenario. Although traffic accidents have a multivariate etiology, mental disorders, such as substance use disorders (SUD) and attention deficit/hyperactivity disorder (ADHD), are often involved. This paper aims at investigating the prevalence of ADHD, SUD and other mental disorders in a sample of Brazilian motoboys, and additionally, to evaluate the association between psychiatric diagnoses, motorcycle accidents and traffic violation tickets. Method. - A convenient sample of subjects was invited to participate in a cross-sectional assessment including an inventory of traffic accidents and violations. Psychiatric diagnoses were based on semi-structured and clinical interviews. Results. - A sample of 101 motoboys was assessed. Overall, 75% of subjects had a positive lifetime history of at least one psychiatric disorder. SUD was the most frequent diagnosis (43.6% for alcohol, 39.6% for cannabis). ADHD was associated with a higher number of traffic accidents (p = 0.002), and antisocial personality disorder (APD) was associated with a greater number of traffic violations (p = 0.007). Conclusions. - The prevalence of mental disorders was much higher in our sample than in the general population. ADHD and APD, but not SUD, were associated with negative traffic outcomes. These findings have implications for public mental health planning since mental disorders can be both prevented and treated, improving driving behavior and increasing road safety.

Lee SY; Hahn CY; Lee JF; Chen SL; Chen SH; Yeh TL et al. MAOA-uVNTR polymorphism may modify the protective effect of ALDH2 gene against alcohol dependence in antisocial personality disorder. Alcoholism: Clinical and Experimental Research 33(6): 985-990, 2009. (58 refs.)

Antisocial alcoholism is related to dopamine and serotonin which are catalyzed by monoamine oxidase A (MAOA) and acetaldehyde dehydrogenase 2 (ALDH2). The objective of this study is to determine whether the interaction between the MAOA and the ALDH2 genes is associated with subjects with antisocial personality disorder (ASPD) having alcoholism. A total of 294 Han Chinese men in Taiwan including 132 ASPD with alcoholism (Antisocial ALC) and 162 without alcoholism (Antisocial Non-ALC) were recruited in this study. Alcohol dependence and ASPD were diagnosed according to DSM-IV criteria. Genotypes of ALDH2 and MAOA-uVNTR were determined using PCR-RFLP. A significant difference of ALDH2 polymorphisms (p = 3.39E-05), but not of MAOA, was found among the 2 study groups. However, only after the stratification of the MAOA-uVNTR (variable number of tandem repeat located upstream) 3-repeat, a significant association between Antisocial Non-ALC and ALDH2*1/*2 or *2/*2 genotypes was shown (p = 1.46E-05; odds ratio = 3.913); whereas stratification of MAOA-uVNTR 4-repeat revealed no association. Multiple logistic regression analysis further revealed significant interaction of MAOA and ALDH2 gene in antisocial ALC (odds ratio = 2.927; p = 0.032). The possible interaction of MAOA and ALDH2 gene is associated with Antisocial ALC in Han Chinese males in Taiwan. However, the protective effects of the ALDH2*2 allele against alcoholism might disappear in subjects with ASPD and carrying MAOA-uVNTR 4-repeat allele in the Han Chinese male population.

Magyar MS; Edens JF; Lilienfeld SO; Douglas KS; Poythress NG. Examining the relationship among substance abuse, negative emotionality and impulsivity across subtypes of antisocial and psychopathic substance abusers. journal of criminal justice 39(3, special issueI): 232-237, 2011. (47 refs.)

Growing evidence suggests that individuals with Antisocial Personality Disorder (ASPD) can be categorized into theoretically meaningful subtypes. This study builds on earlier cluster-analytic research (Poythress et al., 2010) that identified four subtypes of ASPD in a large sample of prison inmates and offenders ordered into mandatory substance abuse treatment. These four subtypes ( primary, secondary, and "fearful" psychopathic and non-psychopathic ASPD) differed in theoretically important ways on various criterion measures. Of those participants in substance abuse treatment (N = 571), we compare the four clusters, as well as non-ASPD substance abusers, in terms of (a) the severity of their self-reported alcohol and drug problems and (b) whether the severity of their substance abuse is predicted by similar etiologically important correlates (i.e., negative emotionality, impulsivity). There were modest subgroup. differences in abuse, although as expected secondary psychopaths reported more severe misuse than primary psychopaths. Associations between impulsivity and negative emotionality and drug use for the total sample were in the expected direction, though relatively modest in magnitude. Unexpectedly, these associations were weaker among psychopathic subtypes relative to the non-psychopathic subgroups. These findings suggest that the etiology of drug use may differ across subgroups of chronically antisocial individuals.

Manza N. Alcohol use and suicidal behavior among college students. (review). International Journal on Disability and Human Development 8(4): 341-347, 2009. (54 refs.)

The central point of this article is to review the evidence supporting a correlation between suicidal behavior and alcohol abuse/dependence among college students. Suicidal behavior often occurs in alcohol-abusing individuals with a history of one or more additional psychiatric disorders. Individuals with prior episodes of major depression are presumed to be at a much greater risk of suicide. Theory suggests that individuals with antisocial personality disorder and borderline personality disorder are more likely to attempt suicide than those without a personality disorder. Additionally, alcohol-dependent individuals show high rates of suicidal behavior, and an estimated 7% of alcoholics die by suicide. Therefore it is plausible to identify a clear relationship between alcohol misuse and suicide, risk among adolescents and adults.

Meier P; Barrowclough C. Mental health problems: Are they or are they not a risk factor for dropout from drug treatment? A systematic review of the evidence. Drugs: Education, Prevention and Policy 16(1): 7-38, 2009. (82 refs.)

Background: A sizeable number of recent studies investigating whether clients with substance misuse and mental health problems (dual diagnosis clients) are at heightened risk of dropout from drug treatment have been published. It is timely that their findings are brought together in a comprehensive review of the current evidence. Aims: The aim of the review is to examine whether dually diagnosed clients are less likely to be retained in drug treatment than clients without mental health problems, and, if so, whether this varies for clients diagnosed with different types of mental health problems. Methods: The review considers peer-reviewed research published after 1 January 1990, which was located using the literature databases Medline and PsycInfo. Predefined search terms were used. Further papers were identified from the bibliographies of relevant publications. Findings: 58 studies (84% from the USA) met the inclusion criteria for the review. The findings suggest that for most clients, having a past history of mental health problems does not influence the likelihood of being retained in drug treatment. The body of evidence regarding concurrent mental health problems is contradictory. On the whole, the majority of studies suggest that neither presence nor severity of depressive, anxiety, or other Axis-I disorders is related to retention, but these findings are not entirely unequivocal, as a few studies report strong positive or negative associations between depression and anxiety disorders and retention. Few researchers looked separately at psychotic spectrum disorders hence no conclusions could be drawn. The presence of most personality disorders also did not appear to affect treatment tenure, with the exception of antisocial personality disorder, for which the evidence points towards a greater risk of dropout. Conclusions: The balance of evidence suggests that, overall, dual diagnosis clients with Axis-I disorders who seek treatment in drug treatment services are retained as well as clients without dual diagnosis. Subgroups of clients who appear more vulnerable to premature dropout include those with antisocial personality disorder. Methodological shortcomings of the reviewed studies and resulting implications for this review and future research are discussed.

Mellos E; Liappas I; Paparrigopoulos T. Comorbidity of personality disorders with alcohol abuse. (review). In Vivo 24(5): 761-769, 2010. (97 refs.)

There is high comorbidity of alcohol dependence with mood, anxiety, substance abuse and personality disorders. Personality disorders, in particular, are considered to be an important contributing and/or predisposing factor in the pathogenesis, clinical course and treatment outcome of alcohol dependence. According to clinical and epidemiological studies, the prevalence of personality disorders in alcoholism ranges from as low as 22-40% to as high as 58-78%. The literature has focused primarily on antisocial and borderline personality disorders; however, almost the whole spectrum of personality disorders can be encountered in alcohol dependence, such as the dependent, avoidant, paranoid and others. A number of factors, such as sampling methods, diagnostic criteria used or assessment procedures applied, may explain this wide variation. The quest of a distinct 'alcoholic personality' dates from the first half of the 20th century but failed to reveal consistent and strong substantiation. However, renewed efforts provided evidence for the importance of impulsivity/disinhibition and neuroticism/negative affecstivity in the development of alcohol dependence; the role of other personality traits such as extraversion/sociability is still unclear. These findings led to a number of typologies, some of the most popular and influential being those of Cloninger, Babor, and Lesch.

Moggi F; Giovanoli A; Buri C; Moos BS; Moos RH. Patients with substance use and personality disorders: A comparison of patient characteristics, treatment process, and outcomes in Swiss and US substance use disorder programs. American Journal of Drug and Alcohol Abuse 36(1): 66-72, 2010. (27 refs.)

Background: Cross-cultural comparisons may increase our understanding of different models of substance use treatment and help identify consistent associations between patients' characteristics, treatment conditions, and outcomes. Objectives: The aim of the study was to compare matched samples of substance use disorder (SUD) patients with personality disorders (PD) in Swiss and the United States (U. S.) residential SUD treatment programs and examine the relationship of program characteristics to 1-year outcomes. Methods: A prospective, naturalistic design was used to compare 132 demographically matched Swiss and U. S. male patients drawn from a sample of 10 Swiss and 15 U. S. public treatment programs. Patients completed comparable inventories at admission, discharge, and 1-year follow-up. Results: Compared to Swiss SUD-PD patients, U. S. SUD-PD patients had more severe substance use and psychosocial problems at admission and followup. More intensive treatment and a stronger emphasis on patients' involvement were related to better outcomes for both Swiss and U.S. SUD-PD patients. Conclusion: There may be some cross-cultural consistency in the associations between treatment characteristics and SUD-PD patients' outcomes. Scientific Significance: Treatment evaluation findings from representative programs in one country may apply elsewhere and contribute to our overall knowledge about how to improve SUD-PD patients' outcomes.

Mutschler J; Grosshans M; Koopmann A; Hermann D; Diehl A; Mann K et al. Supervised disulfiram in relapse prevention in alcohol-dependent patients suffering from comorbid borderline personality disorder: A case series. Alcohol and Alcoholism 45(2): 146-150, 2010. (33 refs.)

Methods: Case history study of patients diagnosed with BPD, prescribed disulfiram in a dose of 1.5-2.5 g/week, supervised by a physician in up to three brief contacts per week. Results: Two out of eight patients remained completely abstinent during the supervised disulfiram therapy over a mean period of 9.25 months. Adherence to treatment was 18.44 +/- 21.78 months. The first relapse occurred after 1.38 +/- 1.41 months. The cumulated time of abstinence was 16.88 +/- 20.48 months. The overall tolerability was considered to be high; dizziness and fatigue appeared in all patients at the beginning of the therapy but did not persist. No serious adverse events or ethanol-disulfiram interactions were observed. No suicidal behaviour was reported. Conclusions: Although case observations should be interpreted with caution, supervised disulfiram seems to deserve further investigation in patients with comorbid BPD, for whom it appears to help prevent alcoholic relapse.

Neale A; Abraham S; Russell J. "Ice" use and eating disorders: A report of three cases. International Journal of Eating Disorders 42(2): 188-191, 2009. (8 refs.)

Objective: To describe the use of crystal methamphetamine hydrochloride "ice," a powerful, synthetic stimulant drug associated with rapid weight loss. Method: We report the first three cases of young women "ice" users requiring admission to a specialized eating disorders unit. Results: Case one had no prior history of an eating disorder and became emaciated following regular use of "ice"; she regarded weight gain positively. Case 2 had polysubstance abuse since early adolescence and commenced binge eating and vomiting in response to weight gain when not using "ice"; she learned to maintain her weight without weight losing behaviors. Case 3 developed anorexia nervosa in early adolescence, required numerous inpatient admissions and commenced using stimulant drugs for weight loss in her late teens; she discharged prematurely. All patients had features of personality disorder on interview and drug abuse had impaired their work and social adjustment. Discussion: "Ice" use may be associated with the onset of disordered eating or used as an efficient weight losing behavior in an established eating disorder.

Neves FS; Malloy-Diniz LF; Correa H. Suicidal behavior in bipolar disorder: What Is the influence of psychiatric co-morbidities? Journal of Clinical Psychiatry 70(1): 13-18, 2009. (48 refs.)

Objective: To assess the frequency of some psychiatric comorbidities found to be associated with suicidal behavior in previous studies and to evaluate their influence on suicidal behavior in a sample of patients with bipolar disorder. Method: We assessed 239 bipolar patients from January 2005 to January 2007. Axis I diagnosis was performed according to the DSM-IV using a structured interview (the Mini-International Neuropsychiatric Interview-Plus), and borderline personality disorder was assessed using the Structured Clinical Interview for DSM-IV Axis II Personality Disorders. Lifetime suicide history was assessed using a semistructured interview in addition to a review of medical records. Results: There were 99 patients (41.4%) with a history of previous suicide attempts. The psychiatric comorbidities associated with suicidal behavior were borderline personality disorder (chi(2) = 36.008, p = .0001), panic disorder (chi(2) 5.537, p = .0 19), alcoholism (chi(2) = 12.820, p = .001), other drug addictions (chi(2) = 10.055, p = .02), generalized anxiety disorder (chi(2) = 10.216, p = .001), and smoking (chi(2) = 9.070, p = .003). However, when logistic regression analyses were used, only the diagnosis of borderline personality disorder remained significant (Wald chi(2) = 19.137 p = .0001). When analyzing the subtypes of suicide attempts, we found that borderline personality disorder and alcoholism were associated with violent suicide attempts. Conclusion: A diagnosis of borderline personality disorder or alcoholism (only for violent subtype of suicidal behavior) was the only comorbidity independently associated with suicide in patients with bipolar disorder. For suicide prevention, screening to identify patients at high risk for suicidal behavior should be performed routinely in patients with bipolar disorder.

New AS; Stanley B. An opioid deficit in borderline personality disorder: Self-cutting, substance abuse, and social dysfunction. (editorial). American Journal of Psychiatry 167(8): 882-885, 2010. (12 refs.)

Peles E; Schreiber S; Adelson M. Pathological gambling and obsessive compulsive disorder among methadone maintenance treatment patients. Journal of Addictive Diseases 28(3): 199-207, 2009. (38 refs.)

The aims of this study was to assess the prevalence of lifetime pathological gambling (pathological gambling) and current obsessive compulsive disorder among former heroin addicts currently in methadone maintenance treatment. A cross-sectional study of 154 patients from a methadone maintenance treatment clinic affiliated of a tertiary-referral medical center was conducted. The South Oaks Gambling Screen and Yale-Brown Obsessive Compulsive Scale were used for measurement purposes. Lifetime pathological gambling was found in 45 (29.2%) patients (current pathological gambling was found in 10 [6.5%] patients). Clinical obsessive compulsive disorder (defined if scored as moderate to extreme) was found in 51.1% of patients in the pathological gambling groups and 39.4% of patients in the non-pathological gambling group, with higher obsessive scores in the pathological gambling group versus the non-pathological gambling group. Logistic regression (multivariate analyses) found pathological gambling in more males (odds ratio = 3.6, 95% confidence interval = 1.5-8.8), a high obsessive score (odds ratio = 1.07, 95% confidence interval = 0.1-1.1), and older age on admission (40 years and older) (odds ratio = 2.4, 95% confidence interval = 1.1-5.0). Because only 10 (6.5%) patients were still currently gambling, more urgent intervention should be considered to the unexpected high rate of clinical obsessive-compulsive disorder (42.9%) in the sample, possibly because the clinic studied is of a higher severity than that accepted to the methadone maintenance treatment clinics in the community.

Preuss UW; Johann M; Fehr C; Koller G; Wodarz N; Hesselbrock V et al. Personality disorders in alcohol-dependent individuals: Relationship with alcohol dependence severity. European Addiction Research 15(4): 188-195, 2009. (34 refs.)

The rate of axis II disorders in alcohol-dependent individuals is suggested to be high. The aim of this investigation is to assess the rate of DSM-IV axis II diagnoses in alcohol-dependent inpatients and their correlation with clinical characteristics of alcohol dependence (AD). 1,079 inpatients with DSM-IV AD from three inpatient addiction treatment centers ('qualified detoxification', open psychiatric university hospital wards) were included. Characteristics of AD were obtained using standardized structured interviews. Diagnoses of DSM-IV personality disorders (PDs) were generated with SCID-II-PQ and SCID-II interviews. Alcoholism severity was measured using the number of DSM-IV criteria endorsed and age at first drinking. Approximately 60% of the sample had at least one PD. However, rates of Axis II disorders differed significantly across centers. The most frequent PDs were obsessive-compulsive, borderline, narcissistic and paranoid PD. Diagnosis of any PD was related to a more severe clinical profile of AD. Regression analyses revealed that obsessive-compulsive PD was related to the number of DSM-IV criteria endorsed while antisocial PD was related to early age at first drinking. The majority of alcohol-dependent individuals had one or more comorbid axis II disorders. Univariate and multivariate analyses indicate that different PDs are related to age at first dinking and alcoholism severity.

Pulay AJ; Stinson FS; Ruan WJ; Smith SM; Pickering RP; Dawson DA et al. The relationship of DSM-IV personality disorders to nicotine dependence: Results from a national survey. Drug and Alcohol Dependence 108(1-2): 141-145, 2010. (36 refs.)

This study examined the prevalence of nicotine dependence (ND) and its associations with DSM-IV personality disorders (PDs) among current smokers (n = 7078), controlling for sociodemographic characteristics and comorbid Axis I and II disorders. Data were derived from a nationally representative sample of the U.S. population. Although all PDs were significantly associated with ND when sociodemographic factors were controlled, only schizotypal, borderline, narcissistic and obsessive-compulsive PDs were associated with ND after adding controls for Axis I and other Axis II disorders. These associations remained significant after controlling for degree of smoking exposure. The results suggest that both shared and PD-specific pathogenetic factors underlie these PD-ND associations. Implications are also discussed in terms of the relationship between personality features of schizotypal, borderline, narcissistic and obsessive-compulsive PDs and the self-medication hypothesis and the role of neurotransmission.

Reese J; Kraschewski A; Anghelescu I; Winterer G; Schmidt LG; Gallinat J et al. Haplotypes of dopamine and serotonin transporter genes are associated with antisocial personality disorder in alcoholics. Psychiatric Genetics 20(4): 140-152, 2010. (78 refs.)

Introduction: A different genetic background is postulated for alcoholics with early onset and with antisocial personality disorder (type 2 alcoholics) compared with those with late onset and without antisocial personality disorder (type 1 alcoholics). The dopamine transporter (DAT) and the serotonin transporter (SERT) are involved in endophenotypes that are associated with these subtypes. Our study was aimed at investigating whether distinct haplotypes, defined by polymorphisms associated with the expressions of DAT and SERT, were associated with subgroups of alcohol dependence. Methods: Intron 8 variable number of tandem repeats (VNTR), exon 15 rs27072 and VNTR (DAT), promoter VNTR and rs25531, and intron 2 VNTR (SERT) were genotyped in a case-control sample comprising 360 alcoholics and 368 controls, and in a family-based sample of 65 trios, all of German origin. Results DAT: The haplogenotypes 6-A-10/6-G-10 and 5-G-9/5-G-9 were more often present in type 2 alcoholics as compared with type 1 alcoholics [odds ratio (OR): 2.8], and controls (OR: 5.8), respectively. The daily ethanol consumption was associated with haplogenotypes. SERT: haplotypes S-A-10 (OR: 2.3) and L-G-12 (OR: 2.5) were more often present in type 2 alcoholics compared with controls. Haplotype L-A-10 was less often present in type 2 alcoholics (OR: 0.5), and was more often transmitted, in families, to the affected offspring (transmission disequilibrium test: OR: 5.2; family-based association test: Z: 1.9). The haplotype L-A-12 was significantly undertransmitted to affected offspring in the whole group (transmission disequilibrium test: OR: 0.216; family-based association test: Z: -2.2). A gene by environment interaction was observed with respect to the time course of the depression score after alcohol withdrawal and with respect to the positive family history of alcohol dependence. Conclusion: Haplotype analysis, sub-grouping with respect to more homogeneous endophenotypes, and inclusion of quantifiable characteristics are sensible strategies to untangle the genetic background of such a complex disorder like alcohol dependence.

Schneider B; Wetterling T; Georgi K; Bartusch B; Schnabel A; Blettner M. Smoking differently modifies suicide risk of affective disorders, substance use disorders, and social factors. Journal of Affective Disorders 112(1-3): 165-173, 2009. (44 refs.)

Background: Although an association between smoking and suicide has repeatedly been shown, information about a modifying influence of smoking on other risk factors for suicide is lacking. Methods: Axis I and Axis II disorders, sociodemographic factors, and tobacco use were assessed by a semi-structured interview including the Structured Clinical Interview for DSM-IV Axis I (SCID-I) and Personality Disorders (SCID-II) in 163 suicides (mean age 49.6+/-19.3 years; 64.4% men;) by psychological autopsy method and by personal interview in 396 living population-based control pet-sons (mean age S 1.6+/-17.0 years; 55.8% men). Results: Smoking status (Current smokers, lifetime non-smokers, and former smokers) differently modifies the effects of psychiatric disorders and sociodemographic variables on suicide risk. Former and Current smoking modified suicide risk associated with affective disorders, but Only Current smoking increased suicide risk for Substance use disorders. Ex-smokers with affective disorders, particularly with major depression, had less increased suicide risk than Current smokers and non-smokers with affective disorders. Estimated Suicide risks for personality disorders and 'no professional training' were strongly increased by smoking. Limitations: Due to the small size of some of the subgroups, confidence intervals are wide. Therefore, precise risk estimation is not possible. Conclusions: Clincians should interpret smoking as an indicator of increased risk of suicide for individuals with substance use disorders, personality disorders, and adverse social factors. Further studies are needed to investigate the effects of smoking cessation on suicide risk of patients with psychiatric disorders such as major depression and substance use disorders.

Seguin M; Boyer R; Lesage A; McGirr A; Suissa A; Tousignant M et al. Suicide and gambling: Psychopathology and treatment-seeking. Psychology of Addictive Behaviors 24(3): 541-547, 2010. (46 refs.)

The aim of this study was to evaluate suicides with a history of problem gambling (PG) and others with no such history (NPG) and to compare the two on mental health problems and service utilization. Data on a sample of 49 PG suicides and 73 NPG suicides were obtained front informants and hospital records. Psychopathology was prevalent in both groups, but problem gamblers were twice as likely to have a personality disorder. Moreover, PG suicides were less in contact with mental health services in their last month, their last year, and their lifetime. NPG suicides consulted specialized services from 3 (last month and last year) to 13 times (lifetime) as often as their PG counterparts. Lower service utilization associated with PG suicides argues in favor of stepping up detection, engagement in care and treatment with respect to problem gambling, especially when comorbidity is present.

Skogen JC; Mykletun A; Ferri CP; Bebbington P; Brugha T; Coid J et al. Mental and personality disorders and abstinence from alcohol: Results from a national household survey. Psychological Medicine 41(4): 809-818, 2011. (41 refs.)

Background. The beneficial outcomes associated with moderate compared with low alcohol intake or abstinence may be due to the inclusion of people as 'low consumers', who have stopped consumption because of poor health. We investigated the association between alcohol abstinence and symptoms of common mental disorder and personality disorder, distinguishing between lifelong abstinence and abstinence following previous consumption. Method. Analyses were based on the British National Survey of Psychiatric Morbidity 2000, which sampled 8580 residents aged 16-74 years. Hazardous drinking (Alcohol Use Disorders Identification Test) was excluded. Symptoms of common mental disorder (depression/anxiety) were identified by the Clinical Interview Schedule. The screening questionnaire of the Structured Clinical Interview for Axis II Personality Disorders was used to identify potential personality disorder. Self-reported alcohol abstinence was divided into lifelong abstinence and previous consumption. Previous consumers were asked why they had stopped. Covariates included socio-economic status, social activity and general health status. Results. After adjustment, alcohol abstinence was associated with both common mental disorder symptoms and any personality disorder, but only for previous consumers, in whom odds ratios were 1.69 (95% CI 1.23-2.32) and 1.45 (95% CI 1.09-1.94). Associations were non-specific, being apparent for most individual mental disorder symptoms and personality disorder categories. More detailed analysis indicated that associations were again limited to previous consumers who reported ceasing alcohol consumption for health reasons. Conclusions. Worse mental health in low alcohol consumers, particularly those who have previously ceased for health reasons, should be taken into account when interpreting associations between moderate (compared with low) alcohol consumption and beneficial health outcomes.

Strat Y; Ramoz N; Gorwood P. In alcohol-dependent drinkers, what does the presence of nicotine dependence tell us about psychiatric and addictive disorders comorbidity? Alcohol and Alcoholism 45(2): 167-172, 2010. (44 refs.)

Methods: Drawn from a US national survey of 43,000 adults The (National Epidemiologic Survey on Alcohol and Related Conditions) who took part in a face-to-face interview, data were examined on the 4782 subjects with lifetime alcohol dependence, and comparisons were made between those with and those without nicotine dependence. Results: Nicotine dependence was reported by 48% of the alcohol-dependent respondents. They reported higher lifetime rates of panic disorder, specific and social phobia, generalized anxiety disorder, major depressive episode, manic disorder, suicide attempt, antisocial personality disorder and all addictive disorders than those without nicotine dependence. After controlling for the effects of any psychiatric and addictive disorder, alcohol-dependent subjects with nicotine dependence were more than twice as likely as non-nicotine-dependent, alcohol-dependent subjects to have at least one other lifetime addiction diagnosis (adjusted odds ratio 2.36; 95% confidence interval 2.07-2.68). Conclusions: Nicotine dependence represents a general marker of psychiatric comorbidity, particularly of addictive comorbidity. It may be used as a screening measure for psychiatric diagnoses in clinical practice as well as in future trials.

Torrens M; Gilchrist G; Domingo-Salyany A. Psychiatric comorbidity in illicit drug users: Substance-induced versus independent disorders. Drug and Alcohol Dependence 113(2-3): 147-156, 2011. (43 refs.)

Background: Few studies have differentiated between independent and substance-induced psychiatric disorders. In this study we determine the risks associated with independent and substance-induced psychiatric disorders among a sample of 629 illicit drug users recruited from treatment and out of treatment settings. Methods: Secondary analysis of five cross-sectional studies conducted during 2000-2006. Independent and substance-induced DSM-IV psychiatric diagnoses were assessed using the Psychiatric Research Interview for Substance and Mental Disorders, Results: Lifetime prevalence of Axis I disorders other than substance use disorder (SUD) was 41.8%, with independent major depression being the most prevalent (17%). Lifetime prevalence of antisocial or borderline personality disorders was 22.9%. In multinominal logistic regression analysis (SUD only as the reference group), being female (OR 2.45; 95% CI 1.59, 3.77) and having lifetime borderline personality disorder (OR 2.45; 95% CI 1.31, 4.59) remained significant variables in the group with independent disorders. In the group with substance-induced disorders, being recruited from an out of treatment setting (OR 3.50; 95% CI 1.54, 7.97), being female (OR 2.38; 95% CI 1.24, 4.59) and the number of SUD (OR 1.31; 95% CI 1.10, 1.57) remained significant in the model. These variables were also significant in the group with both substance-induced and independent disorders, together with borderline personality disorder (OR 2.53; 95% CI 1.03, 6.27). Conclusions: Illicit drug users show high prevalence of co-occurrence of mainly independent mood and anxiety psychiatric disorders. Being female, recruited from an out of treatment setting and the number of SUD, are risk factors for substance-induced disorders.

Trull TJ; Jahng S; Tomko RL; Wood PK; Sher KJ. Revised NESARC personality disorder diagnoses: Gender, prevalence, and comorbidity with substance dependence disorders. Journal of Personality Disorders 24(4): 412-426, 2010. (24 refs.)

We applied different diagnostic rules for diagnosing personality disorders to the NESARC epidemiological study of over 40,000 individuals. Specifically, unlike previous NESARC publications, we required that each personality disorder criterion be associated with significant distress or impairment in order to be counted toward a personality disorder (PD) diagnosis. Results demonstrated significant reductions in prevalence rates for PDs (9.1% versus 21.5% using original NESARC algorithms), and these revised prevalence rates were much more consistent with recent epidemiological studies in the U.S. and Great Britain. We also found gender differences in the prevalence rate for most PDs. Comorbidity analyses revealed strong associations between PDs and alcohol dependence, drug dependence, and tobacco dependence. PD diagnoses were also associated with scores on dysfunction and impairment, perceived stress and less social support, lifetime history of suicide attempts, interpersonal difficulties, and problems with legal authorities.

Ullrich S; Coid J. Antisocial personality disorder: Co-morbid Axis I mental disorders and health service use among a national household population. Personality and Mental Health 3(3): 151-164, 2009. (49 refs.)

Antisocial personality disorder is highly co-morbid with other mental disorders, particularly substance use disorders, but little is known about the use of mental health services among this group. The study investigated the use of mental health services and associations with psychiatric co-morbidity among persons with a diagnosis of antisocial personality disorder within a representative UK household population. Weighted data from 8 395 respondents included 245 (2.9%) with a diagnosis of antisocial personality disorder. This diagnosis resulted in independent risks of substance abuse disorders, suicide attempts and generalized anxiety disorders when compared with the general population. Help-seeking behaviour was more prevalent among the antisocial group than the general population but was primarily mediated through co-morbid Axis I mental disorders and was not because of antisocial symptoms or other co-morbid personality disorders. Among those with antisocial personality disorder, approximately one-quarter had consulted a mental health professional in the year before interview. Of those, nearly 70% suffered from a co-morbid anxiety disorder. High use of mental health services among persons with antisocial personality disorder appears to be a characteristic of a specific subgroup with high levels of anxiety.

Vaughn MG; Define RS; DeLisi M; Perron BE; Beaver KM; Fu QA et al. Sociodemographic, behavioral, and substance use correlates of reckless driving in the United States: Findings from a national sample. Journal of Psychiatric Research 45(3): 347-353, 2011. (29 refs.)

This study examined the sociodemographic, behavioral, psychiatric, and substance use correlates of three forms of reckless driving using a nationally representative sample of U.S. adults. Participants were 43,093 adults from the National Epidemiologyogic Survey on Alcohol and Related Conditions (NESARC). Interviewers administered the Alcohol Use Disorder and Associated Disabilities Interview Schedule - DSM-IV version (AUDADIS-IV). This measure provides extensive sociodemographic data as well as diagnoses for mood, anxiety, personality, and substance use disorders. Reckless driving was significantly associated with male gender, lower levels of income, being born in the U.S., and numerous forms of antisocial behaviors. Fully adjusted models revealed significant effects with respect to substance use disorders across categories of reckless drivers with those having their licenses revoked or suspended being particularly more likely to be diagnosed with antisocial (AOR = 3.35, 95% CI = 2.54, 4.42) and paranoid personality disorder (AOR = 1.56, 95% CI = 1.07, 2.29). All three reckless driving groups were more likely to have a family history of antisocial behavior than non-reckless drivers. Study findings provide information from which targeted behavioral interventions can be applied.

Vaughn MG; Fu Q; Delisi M; Beaver KM; Perron BE; Howard MO. Criminal victimization and comorbid substance use and psychiatric disorders in the United States: Results from the NESARC. Annals of Epidemiology 20(4): 281-288, 2010. (33 refs.)

PURPOSE: Criminal victimization produces enormous personal and societal costs, yet few investigations have systematically examined substance use and psychiatric disorders of crime victims. Our objectives were to (i) examine the prevalence and patterns of criminal victimization in the United States and (ii) their associations with specific substance use disorders, prevalent psychiatric conditions, and violent and nonviolent antisocial behaviors in controlled multivariate analyses. METHODS: Data were derived from the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative sample of US residents 18 years of age and older (N = 43,093). Interviews conducted between 2001 and 2002 included measures of past-year criminal victimization and Diagnostic and Statistical Manual of Mental Disorders, IV mood, anxiety, substance use, and personality disorders. RESULTS: More than 1-in-25 adults in the United States (4.1%) reported past-year criminal victimization. Respondents who reported lower levels of income, lived in urban areas, and were separated or divorced were at significantly heightened risk for criminal victimization. Persons reporting various forms of violent and nonviolent antisocial behavior also were more likely to be victims of crime. In controlled multivariate analyses, crime victims evidenced significantly increased rates of alcohol, cocaine, and opioid use disorders. Paranoid personality disorder, major depressive disorder, and a family history of antisocial behavior were also significantly associated with past-year criminal victimization. CONCLUSIONS: Criminal victimization is prevalent in the United States and associated with significant psychiatric comorbidities and behavioral dysfunction. Poor, unmarried persons living in urban areas who have family histories of antisocial conduct and personal histories of specific substance use and psychiatric disorders are at substantially elevated risk for criminal victimization.

Walter M; Degen B; Treugut C; Albrich J; Oppel M; Schulz A et al. Affective reactivity in heroin-dependent patients with antisocial personality disorder. Psychiatry Research 187(1-2): 210- 213, 2011. (48 refs.)

The Antisocial personality disorder (ASPD), one of the most common co-morbid psychiatric disorders in heroin-dependent patients, is associated with a lack of affective modulation. The present study aimed to compare the affect-modulated startle responses of opioid-maintained heroin-dependent patients with and without ASPD relative to those of healthy controls. Sixty participants (20 heroin-dependent patients with ASPD, 20 heroin-dependent patients without ASPD, 20 healthy controls) were investigated in an affect-modulated startle experiment. Participants viewed neutral, pleasant, unpleasant, and drug-related stimuli while eye-blink responses to randomly delivered startling noises were recorded continuously. Both groups of heroin-dependent patients exhibited significantly smaller startle responses (raw values) than healthy controls. However, they showed a normal affective modulation: higher startle responses to unpleasant, lower startle responses to pleasant stimuli and no difference to drug-related stimuli compared to neutral stimuli. These findings indicate a normally modulated affective reactivity in heroin-dependent patients with ASPD.

Walter M; Gunderson JG; Zanarini MC; Sanislow CA; Grilo CM; McGlashan TH et al. New onsets of substance use disorders in borderline personality disorder over 7 years of follow-ups: findings from the Collaborative Longitudinal Personality Disorders Study. Addiction 104(1): 97-103, 2009. (70 refs.)

Aims: The purpose of this study was to examine whether patients with borderline personality disorder (BPD) have a higher rate of new onsets of substance use disorders (SUD) than do patients with other personality disorders (OPD). Design: This study uses data from the Collaborative Longitudinal Personality Disorder Study (CLPS), a prospective naturalistic study with reliable repeated measures over 7 years of follow-up. Setting: Multiple clinical sites in four northeastern US cities. Participants: A total of 175 patients with BPD and 396 patients with OPD (mean age 32.5 years) were assessed at baseline and at 6, 12, 24, 36, 48, 60, 72 and 84 months. Measurements: The Structured Clinical Interview for DSM-IV Axis I Disorders and the Diagnostic Interview for DSM-IV Personality Disorders were used at baseline, the Follow-Along version of the DIPD-IV and the Longitudinal Interval Follow-up Evaluation at the follow-up evaluations. Kaplan-Meier analyses were calculated to generate the time to new onsets. Findings: BPD patients showed a shorter time to new onsets of SUD. Thirteen per cent of BPD patients developed a new alcohol use disorder and 11% developed a new drug use disorder, compared to rates of 6% and 4%, respectively, for OPD. Non-remitted BPD and remitted BPD patients did not differ significantly in rates of new onsets of SUD. Conclusions: BPD patients have a high vulnerability for new onsets of SUDs even when their psychopathology improves. These findings indicate some shared etiological factors between BPD and SUD and underscore the clinical significance of treating SUD when it co-occurs in BPD patients.

Weizmann-Henelius G; Putkonen H; Naukkarinen H; Eronen M. Intoxication and violent women. Archives of Women's Mental Health 12(1): 15-25, 2009. (55 refs.)

Alcohol and drugs have been linked to severe violent offending among women as well as men. The purpose of this study was to make a contribution to the limited knowledge of characteristics related to the state of intoxication in violent female offenders. The putative differences in the characteristics of female offenders and their violent offenses in relation to the state of intoxication at the time of the violent offending were examined. Of a nation-wide sample of 109 female offenders found guilty of homicide and other violent crimes and incarcerated in 1999-2000 in Finland, 60 offenders participated in the study. Of these offenders 49 (81.7%) had been intoxicated at the time the of index offenses. These were compared with 11 (18.3%) non-intoxicated offenders using a structured interview, the Structured Clinical Interview II for DSM-IV (SCID-II) and the Hare Psychopathy Checklist-Revised (PCL-R). The prevalence of substance abuse or dependence (73.3% and 0%), personality disorder (89.6% and 36.4%), particularly antisocial personality disorder (66.7% and 0%), as well as a history of criminality (69.4% and 0%) were significantly higher among the intoxicated women than among the non-intoxicated. The PCL-R scores were also significantly higher among the intoxicated offenders than among non-intoxicated offenders. The victims of the intoxicated women (23.9%) were less often emotionally close to the perpetrator than were the victims of the non-intoxicated women (66.6%). No differences emerged between the groups in experiences of childhood and adulthood abuse or stressful life events prior to the index crime. The findings indicate that intoxicated violent female offenders exhibit more of the characteristics previously found in violent men, than do the non-intoxicated female offenders. Moreover, the non-intoxicated group comprises both psychotic non-responsible and non-psychotic, fairly well-adjusted women, who are educated, working or studying at the time of the offense and has no history of criminality. Substance misuse constitutes an obvious risk factor for violent behavior in women, and therefore the prevention should include substance abuse treatment.

Willinger BI. Interventions for HIV clients with co-occurring substance use and personality disorders. Social Work in Health Care 49(5): 444-457, 2010. (34 refs.)

Many HIV/AIDS clients who currently need some form of psychosocial intervention are individuals diagnosed with substance use, a mental health problem, or both. In any setting a proportion of these clients, because of their behaviors, present myriad challenges to individual providers in terms of engagement in medical care, medication adherence, and difficulty with interpersonal skills. These clients struggle with how to appropriately express their needs. Providers struggle to understand and respond to clients' escalating and disruptive behaviors in a therapeutic, concerned, and consistent manner. This case-based article, which highlights strategies, interventions, and client vignettes, will focus on these issues.

Winslow M; Subramaniam M; Qiu SJ; Lee A. Socio-demographic profile and psychiatric comorbidity of subjects with pathological gambling. Annals of Medicine Singapore 39(2): 122-128, 2010. (32 refs.)

Introduction: Pathological gambling is defined as the failure to resist the impulse to gamble despite disruption to personal, family and vocational life. It appears to be highly comorbid with psychiatric disorders. This study aims to describe the socio-demographic profile and comorbidity of 40 pathological gamblers compared to controls. Materials and Methods: Questionnaires were administered to 40 cases (90% male, mean age = 38.3, SD = 10.0) scoring 5 or more in the South Oaks Gambling Screen (SOGS) and verified to be pathological gamblers based on DSM-IV criteria and 40 age-and-gender-matched controls. Results: Study results showed that the prevalence of lifetime DSM-IV diagnoses were significantly different between cases and controls (chi(2) = 16.4, P<0.001), with 67.5% of the cases and 22.5% of the controls meeting the criteria, respectively. Eighty percent of the cases had at least one personality disorder compared to 45% in the control (chi(2) = 10.5, P <0.005). The common lifetime disorders observed in the cases were substance abuse disorder and anxiety while common personality disorders were obsessive-compulsive, avoidant and paranoid. Conclusion: This study highlights the high rates of comorbidity in a largely Chinese sample in an Asian setting and the importance of assessing pathological gamblers for comorbidities.

Xian H; Scherrer JF; Pergadia ML; Madden PAF; Grant JD; Sartor CE et al. Contribution of parental psychopathology to offspring smoking and nicotine dependence in a genetically informative design. Journal of Studies on Alcohol and Drugs 71(5): 664-673, 2010. (34 refs.)

Objective: It is not known if parental psychiatric disorders have an independent effect on offspring smoking after controlling for genetic and environmental vulnerability to nicotine dependence. We tested if parental alcohol, drug, or conduct disorders; antisocial personality disorder; depression; and anxiety disorders remained significant predictors of offspring smoking initiation, regular smoking, and nicotine dependence before and after adjusting for genetic and environmental risk for nicotine dependence. Method: Data were obtained via semi-structured interviews with 1,107 twin fathers, 1,919 offspring between the ages of 12 and 32, and 1,023 mothers. Genetic and environmental liability for smoking outcomes was defined by paternal and maternal nicotine dependence. Multinomial logistic regression models were computed to estimate the risk for offspring trying cigarettes, regular smoking, and the Fagerstrom Test for Nicotine Dependence (FTND) as a function of parental psychopathology and sociodemographics before and after adjusting for genetic and environmental vulnerability to nicotine dependence. Results: Before adjusting for genetic and environmental risk for nicotine dependence, ever trying cigarettes was associated with maternal depression, regular smoking was associated with maternal alcohol dependence and maternal conduct disorder, and FTND was associated with paternal and maternal conduct disorder and antisocial personality disorder. No parental psychopathology remained significantly associated with regular smoking and FTND after adjusting for genetic and environmental vulnerability to nicotine dependence in a multivariate model. Conclusions: The association between parental psychopathology and offspring smoking outcomes is partly explained by genetic and environmental risk for nicotine dependence. Point estimates suggest a trend for an association between parental antisocial personality disorder and offspring regular smoking and nicotine dependence after adjusting for genetic and environmental vulnerability. Studies in larger samples are warranted.

Ybrandt H. Risky alcohol use, peer and family relationships and legal involvement in adolescents with antisocial problems. Journal of Drug Education 40(3): 245-264, 2010. (61 refs.)

The aim of the study was to examine risk and vulnerability factors contributing to problems with alcohol use in adolescence. Data relating to seven life areas (medical status, school status, social relationships, family background and relationships, psychological functioning, legal involvement, and alcohol use) was gathered using the ADAD (Adolescent Drug Abuse Diagnosis) interview. A total of 1163 Swedish adolescents (809 boys and 354 girls) between the ages of 12 and 20 years old were interviewed. All had antisocial problems and were detained at special youth homes. It was found that for those aged between 12 and 18 years, the general risk factors for alcohol use were leisure and peer problems, problems associated with family background and relationships, and criminal behavior. These results suggest that drug abuse treatment planning should focus on altering the predisposing factors that exist in these domains. It was also found that the ADAD problem areas seem to be most useful as prognostic indicators of treatment outcome for adolescents with antisocial problems who are under 18 years of age.

Zanarini MC; Frankenbur FR; Weingeroff JL; Reich DB; Fitzmaurice GM; Weiss RD. The course of substance use disorders in patients with borderline personality disorder and Axis II comparison subjects: A 10-year follow-up study. Addiction 106(2): 342-348, 2011. (34 refs.)

Aim: The purpose of this study is to detail the course of substance use disorders (SUDs) over 10 years of prospective follow-up among patients with borderline personality disorder (BPD) and Axis II comparison subjects. Design: This study uses data from the McLean Study of Adult Development (MSAD), a multi-faceted study of the longitudinal course of BPD using reliable repeated measures administered every 2 years over a decade of prospective follow-up. Setting: All subjects were initially in-patients at McLean Hospital in Belmont Massachusetts. Participants: A total of 290 patients with BPD and 72 Axis II comparison subjects were assessed at baseline and five waves of follow-up. Measurements: The Structured Clinical Interview for DSM-III-R Axis I Disorders (SCID-I), the Revised Diagnostic Interview for Borderlines (DIB-R) and the Diagnostic Interview for DSM-III-R Personality Disorders (DIPD-R) were administered six times. Generalized estimating equations were used to assess longitudinal prevalence of SUDs. Kaplan-Meier analyses were used to assess time-to-remission, recurrence and new onsets of SUDs. Results: The prevalence of SUDs among borderline patients and Axis II comparison subjects declined significantly over time, while remaining significantly more common among those with BPD. More than 90% of borderline patients meeting criteria for a SUD at baseline experienced a remission by 10-year follow-up. Recurrences and new onsets of SUDs were less common (35-40% and 21-23%). Conclusions: Remissions of alcohol and drug abuse/dependence among borderline patients are both common and relatively stable. Results also suggest that new onsets of these disorders are less common than might be expected.

Zikos E; Gill KJ; Charney DA. Personality disorders among alcoholic outpatients: Prevalence and course in treatment. Canadian Journal of Psychiatry 55(2): 65-73, 2010. (50 refs.)

Objective: To determine the prevalence of concurrent personality disorders (PDs) among alcoholic men and women seeking outpatient treatment, and to examine their effect on the course of alcohol treatment. Method: Patients with alcohol use disorders (n = 165) were assessed by clinical and semi-structured interviews, as well as self-report scales, to measure levels of psychological distress, impulsivity, social functioning, and addiction severity at treatment intake. PD diagnoses were assessed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Personality Disorder (SCID-II). Course in treatment was monitored prospectively for 12 weeks. Results: Using the results of the SCID-II (n = 138), the sample was divided into 3 groups-that is, no PD 41% (n = 57), Cluster B PD 32% (n = 44), and other PD 27% (n = 37). The 3 groups did not differ in their alcohol use severity at intake. However, the Cluster B PD group achieved alcohol milestones at a younger age. Subjects with a PD had more severe psychological and social problems at intake. The Cluster B PD group showed significantly higher levels of impulsivity at intake, greater likelihood of early treatment dropout, and quicker times to first slip and to relapse. Conclusions: This study supports the high prevalence of concurrent PDs, particularly Cluster B PDs, among treatment-seeking alcoholics. The relation between observed high levels of impulsivity and worse course in early alcohol treatment among people with a Cluster BPD merits further investigation.