Axis II comorbidity in substance abusers

To assess the complex relationship between substance abuse and personality disorders, the authors determined the prevalence of personality disorders in a group of middle-class substance abusers and compared the subjects who had personality disorders with those who did not.

The subjects were drawn from patients consecutively admitted to an inpatient substance abuse program in a private psychiatric hospital; they were the first 100 who agreed to participate. Substance dependence was diagnosed according to DSM-III-R, and the patients were assessed with the Structured Clinical Interview for DSM-III-R Personality Disorders, Alcohol Use Inventory, MMPI, Health and Daily Living Form, Shipley Institute of Living Scale, and measures of chemical use and life satisfaction.

Of the 100 substance abusers, 57 had personality disorders. These patients differed significantly from the 43 patients without personality disorders in several ways: they had greater involvement with illegal drugs, had different patterns of alcohol use, had greater psychopathology, were less satisfied with their lives, and were more impulsive, isolated, and depressed.

Because of the marked differences between the substance abusers with and without personality disorders, a uniform approach to substance abuse treatment may be inadequate.