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Personality disorders in opiate addicts show prognostic specificity
T A Kosten1, T R Kosten, B J Rounsaville
1Department of Psychiatry, Yale University School of Medicine, New Haven, CT.
Journal of Substance Abuse Treatment
|January 1, 1989
Summary
Comorbid personality disorders in opioid addiction predict different outcomes. Borderline personality disorder is linked to more depression and alcoholism, but also greater recovery, while antisocial and narcissistic personality disorders correlate with specific legal and medical issues, respectively.
Area of Science:
- Psychiatry
- Addiction Medicine
- Clinical Psychology
Background:
- Early research sought an "addictive personality" in opiate addiction.
- Later studies identified common but heterogeneous personality disorders among opiate addicts.
Purpose of the Study:
- To investigate if distinct comorbid personality disorders offer prognostic specificity in treated opioid addicts.
- To determine if personality disorders predict specific psychiatric and functional outcomes.
Main Methods:
- A 2.5-year follow-up study of 150 treated opioid addicts.
- Assessment of depression, alcoholism, and specific problems using DSM-III criteria and the Addiction Severity Index (ASI).
Main Results:
- Borderline personality disorder predicted higher rates of depression and alcoholism, yet also indicated greater recovery from these conditions.
- Antisocial personality disorder was associated with more legal problems.
- Narcissistic personality disorder correlated with more medical problems.
- Patients with borderline personality disorder exhibited more severe overall psychiatric issues per the ASI.
Conclusions:
- Comorbid personality disorders in opioid addiction have prognostic value, influencing the course and specific challenges faced by patients.
- Treatment for opioid addiction should be individualized based on the patient's specific comorbid personality disorder diagnosis.
- Tailored interventions can address the unique needs predicted by personality disorders, potentially improving treatment outcomes.