Faculty Bibliography

Alcohol use disorders (AUDs) include a spectrum of alcohol-related disorders such as alcohol misuse, abuse, and dependence. AUDs are a group of common, chronic diseases caused by a complicated interaction between biological, psychological, social, and cultural factors. Approximately two-thirds of all American adults, 18 years of age and older, drink some alcohol during the course of a year. Moreover, approximately 7.5% of the United States population (approximately 14 million people) meet criteria for alcohol abuse or dependence. At present, there are two types of medications that are used to treat alcoholism. The first are aversive medications, with disulfiram being the most commonly used. By causing an aversive reaction when taken with alcohol, these medications deter further alcohol consumption through negative reinforcement. However, they are limited in utility unless given in a supervised setting. The second, are those that have anti-craving effects. One of the medications, naltrexone, an opiate antagonist, was first approved by the Food and Drug Administration in 1994. Since there is a limited number of biological interventions for alcoholism at present, most treatment consists of nonpharmacologic psychosocial treatments.

The presence of a personality disorder (PD) has been associated with certain types of poor treatment outcomes in patients with substance use disorders (SUDs). The purpose of this study was to determine the prevalence of comorbid PDs in psychiatrically hospitalized adults with both non-SUD Axis I disorders and SUDs, and to assess the relationship between Axis II psychopathology and degree of pretreatment addiction severity and treatment outcome. METHOD: One hundred consecutive inpatients admitted to a mixed dual diagnosis inpatient unit were assessed using semistructured interviews for SUDs, non-SUD Axis I disorders, and PDs. Pretreatment severity was assessed using a modified version of the Addiction Severity Index (ASI). Outcome measures were assessed both during hospitalization and at an initial follow-up appointment after discharge. Statistical analyses were performed comparing dually diagnosed patients with and without Axis II psychopathology. RESULTS: A significant number (53%) of the patients met criteria for at least one personality disorder. Of the PDs, Cluster B PDs were the most prevalent, particularly borderline personality disorder (74%) and antisocial personality disorder (66%). Dually diagnosed patients without an Axis II diagnosis had less severe pretreatment severity measures. During hospitalization, patients with Axis II disorders had higher levels of psychopathology on the Brief Symptom Inventory (BSI) subscales of sensitivity and hostility. However, there was no difference in overall degree of global improvement during hospitalization. During follow-up, patients with Axis II disorders were significantly less likely to be compliant in attending their initial follow-up appointment. CONCLUSIONS: Dual diagnosis inpatients with PDs appear to improve as much as patients without PDs during their inpatient hospitalizations; however, they appear to be less likely to be compliant with attending their initial follow-up appointment