Academic journal article Alcohol Research

Co-Occurrence of 12-Month Alcohol and Drug Use Disorders and Personality Disorders in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions

Academic journal article Alcohol Research

Co-Occurrence of 12-Month Alcohol and Drug Use Disorders and Personality Disorders in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions

Article excerpt

Background: Very little information is available on the co-occurrence of different personality disorders (PDs) and alcohol and drug use disorders in the U. S. population. Objective: To present national data on sex differences in the co-occurrence of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) alcohol and drug use disorders and 7 of the 10 DSM-IV PDs. Design: Face-to-face interviews conducted in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (N = 43,093). Setting: The United States and the District of Columbia, including Alaska and Hawaii. Participants: Household and group-quarters residents, age 18 and older. Results: Among individuals with a current alcohol use disorder, 28.6 percent (95 percent confidence interval [CI], 26.7-30.6) had at least one PD, whereas 47.7 percent (95 percent CI, 43.9-51.6) of those with a current drug use disorder had at least one PD. Further, 16.4 percent (95 percent CI, 15.1-17.6) of individuals with at least one PD had a current alcohol use disorder, and 6.5 percent (95 percent CI, 5.7-7.3) had a current drug use disorder. Associations between PDs and alcohol and drug use disorders were overwhelmingly positive and significant (P < .05). Overall, alcohol use disorders were most strongly related to antisocial (odds ratio [OR], 4.8; 95 percent CI, 4.1-5.6), histrionic (OR, 4.7; 95 percent CI 3.8-5.8), and dependent (OR, 3.0; 95 percent CI, 1.9-4.8) PDs. Drug use disorders also were more highly associated with antisocial (OR, 11.8; 95 percent CI, 9.7-14.3), histrionic (OR, 8.0; 95 percent CI, 6.0-10.7), and dependent (OR, 11.6; 95 percent CI, 7.1-19.1) PDs. Associations between obsessive-compulsive, histrionic, schizoid, and antisocial PDs and specific alcohol and drug use disorders were significantly stronger (P < .04) among women than men, whereas the association between dependent PD and drug dependence was significantly greater (P < .04) among men than women. Conclusions: The co-occurrence of PDs with alcohol and drug use disorders is pervasive in the U. S. population. Results highlight the need for further research on the underlying structure of these disorders and the treatment implications of these disorders when comorbid.

Numerous studies have addressed the prevalence of personality disorders (PDs), especially antisocial PD, among alcohol and drug abusers.1 They show a high but variable rate of a broad range of PDs in alcohol and drug abusers, and several among them have demonstrated the adverse effect of these disorders on duration of stay in treatment and outcome.2-9 Studies of alcohol and drug use disorders among patients seeking treatment for personality psychopathology are rare. A recent study,10 however, has found high prevalences of alcohol and drug use disorders in patients seeking treatment for PDs. With few exceptions, psychiatric comorbidity in these clinical studies did not differentiate between alcohol and drug use disorders, and these studies were conducted in predominantly male samples. That this literature has paid little attention to sex differences is sur-prising, considering that the importance of distinguishing men and women is firmly established in the field of substance use disorder research.

From an epidemiological perspective, however, a more serious problem with research on comorbidity in clinical studies is that the samples of subjects do not represent the underlying populations. Because of this problem, it is necessary to turn to general population samples for more accurate and precise information on the comorbidity of PDs and alcohol and drug use disorders. However, large epidemiologic surveys conducted in the United States during the past two decades have focused exclusively on the prevalence and comorbidity of antisocial PD and alcohol and drug use disorders.11,12 With the exception of antisocial PD, we have very limited knowledge of the comorbidity between the range of PDs and alcohol and drug use disorders and whether these associations differ between men and women. …

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