The Relevance of Personality Disorders in Addiction Treatment

Editorial

The Relevance of Personality Disorders in Addiction Treatment

Corresponding author : Dr.Adriano Schimmenti, DClinPsych, UKE – Kore University of Enna Cittadella Universitaria 94100, Enna, Italy.
Introduction

Comorbid substance addiction and mental illness is highly prevalent and often results in negative treatment outcomes. For example, it is quite common  for patients with dual  diagnosis to drop-out of treatment. Identifying the  origins of this and other possible negative outcomes can be crucial for treating addictive disorders.

Literature has showed that substance use is associated with a  plethora of  psychiatric  symptoms and  syndromes, such as anxiety, depression, eating disorders, stressorrelated disorders, and personality disorders, among others. In particular, rates of personality disorders in people with addictive disorders are  exceptionally higher than  in the general   population. Just  to make an example, the   prevalence of  borderline  personality disorder in  adult population  is estimated at about 2.7% , and about 78% of people suffering  from borderline personality disorder also develop a substance-related disorder or addiction at some time in their lives [1]. Comorbid personality disorders may complicate the treatment of addicted patients: usually these patients  show more  severe  patterns of   substance  use, and  they even  show  social  problems at a higher degree  than
their peers without personality disorders, resulting in an elevated risk for non-completing treatment. Completion of addiction treatment, in turn, is one of the most consistent factors associated with a favorable treatment outcome [2].

Empirical  studies  on the  role of  personality  disorders  in  substance  addiction  have focused  primarily on  borderline and antisocial personality disorders. However, almost the whole spectrum of personality disorders can be encountered in patients who suffer from addictive behaviors, including narcissistic, dependent, avoidant, and  other personality disorders [3]. In fact, clinical  experience  suggests that  denial, deceitfulness and resistance to  change are   all potential barriers  that  are often encountered when treating  patients with  substance use. These  barriers  are likely the  results of personality disorders and other  dysfunctional  personality  traits,  and they are  mirrored in  problems with therapeutic alliance, which in turn can precipitate a relapse to addictive behaviors thus preventing succesful treatment in many cases.

Research has  already  provided  evidence  for the  importance  of  dysfunctional  personality  traits in the  development  of addictive disorders [4]. especially in the domains of negative affectivity (e.g. emotional lability and separation insecurity) and disinhibition (impulsivity and risk taking). Therefore, the treatment of patients who suffer from addictive disorders could result more effective  when personality disorders are also addressed. Luckily, knowledge about the effectiveness of dually focused treatments (i.e. treatments addressing both substance addiction and personality disorders) is slowly emerging [5], although integrated treatment programs are still lacking and research in this field continues to be limited.

Patients  with  substance  addiction  may  need  tailored  clinical  interventions  that  are  able  to  promote  their  often underdeveloped affect regulation and mentalizing abilities [6]. At the same time, other key variables must be considered and addressed for an effective treatment, such as compliance with therapy, treatment retention, and collapse of drug using patterns. This requires a careful assessment of patient’s personality disorders and dysfunctional personality traits. These can foster substance addiction, can disrupt the therapeutic alliance, and can even prevent a positive treatment outcome.

Clinical work still needs comprehensive models for the understanding and treatment of substance addiction based on personality and psychopathology research. I am confident that our Journal will be at the forefront of this research.

 References

1. Kienast T, Stoffers J, Bermpohl F, Lieb K. Borderline personality disorder and comorbid addiction: epidemiology and treatment. Deutsches Arzteblatt International. 2014, 111(16): 280-286.

2 .Brorson H H, Ajo Arnevik E, Rand-Hendriksen K, and Duckert F. Drop-out from addiction treatment: A systematic review of risk factors. Clinical Psychology Review. 2013, 33(8): 1010-1024.

3.Mellos E, Ioannis L and Paparrigopoulos T. Comorbidity of personality disorders with alcohol abuse. In Vivo. 2010, 24(5): 761-770.

4. Kornør H and Nordvik H. Five-factor model personality traits in opioid dependence. BMC Psychiatry. 2007, 6(7): 37.

5. Tiet Q Q and Mausbach B. Treatments for patients with dual diagnosis: A review.  Alcoholism: Clinical and Experimental    Research. 2007, 31(4): 513-536.

6. Caretti V, Craparo G and Schimmenti A. Fattori evolutivo-relazionali dell’addiction: uno studio sulla dipendenza da eroina [Developmental and relational risk factors of addiction: a study on heroin dependence]. In V. Caretti V & D. La Barbera. Addiction. 2010, 99-131.

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