Psychiatric comorbidity and personality structure in patients with polyvalent addiction

This study focuses on the systematic psychiatric evaluation of polydrug-using opiate-dependent patients, using the standard DSM-IV diagnostic interviews and a new psychodynamic instrument operationalizing personality organization (Structured Interview of Personality Organization, STIPO).

50 patients were interviewed with the Structured Clinical Interview for DSM-IV Disorders (SCID) I and II and the STIPO by two independent researchers at a detoxification treatment unit.

According to the SCID I and II, all patients had at least one axis I disorder, 90% at least one axis II disorder. A correspondence was found between STIPO and SCID results, in that more pathology in the SCID coincided with more severity in the STIPO. According to the STIPO, 100% of the patients were located at the level of borderline personality organization, indicating identity pathology according to Kernberg's model.

Given the fact that comorbid psychiatric disorders compromise the outcome of detoxification and dehabituation treatments, it is highly relevant to diagnose these disorders and to assess underlying personality pathology. While the evidence of psychosocial treatments in addiction therapy is still weak, the integration of syndrome-tailored treatment modules may help improve the treatment of patients with this chronically relapsing condition.

small sample size.