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Cited by 93Personality Disorders and PsychopathologySubstance Abuse Treatment and OutcomesPersonality Traits and Psychology

Comorbidity of Personality Disorder among Substance Use Disorder Patients: A Narrative Review

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Parmar, Arpit, Kaloiya, Gaurishanker·2018·Indian Journal of Psychological Medicine
DOI 10.4103/ijpsym.ijpsym_164_18PMC PMC6241194
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Abstract

Comorbidity of personality disorders (PDs) and substance use disorders (SUDs) is common in clinical practice. Borderline PD and antisocial PD are particularly found to be associated with SUDs. Our review suggests that the overall prevalence of PD ranges from 10% to 14.8% in the normal population and from 34.8% to 73.0% in patients treated for addictions. Even though the types of PD seen in patients with drug and alcohol use disorder are similar, the prevalence of any PD is higher among patients with drug use disorder than alcohol use disorder. The higher comorbidity between these two conditions has been explained by a primary personality pathology followed by a secondary development of a SUD. The comorbidity with PD positively correlates with the severity of the SUD. Comorbid PD among patients with SUDs is a predictor of poor prognosis in terms of poorer treatment response and outcome. Psychotherapy is the mainstay of treatment in comorbid condition with dialectical behavioral therapy, dynamic deconstructive psychotherapy, and dual-focused schema therapy having the most evidence base. Pharmacotherapy is primarily indicated for the acute crisis management or for the treatment of other comorbid conditions such as psychosis and depression. However, the evidence is insufficient as of now to suggest one treatment over the other. Further research is required to identify more efficacious treatment approaches for this comorbidity.

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  • Poverty, acculturation, and personality disorders appear to be risk factors for addiction in AIAN individuals as well.

    “Consistent with prior research in non-AIAN samples, poverty, acculturation, and personality disorders [95,96,97,98] appear to be risk factors for addiction in AIAN individuals as well [33,43,50].”

    From Substance and Behavioral Addictions among American Indian and Alaska Native Populations (2022) · cites this paper as [97]

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References 83 · Cited by 93

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  1. [4]Torgersen S Kringlen E Cramer V The prevalence of PD in a community sample Arch Gen Psychiatry 2001 58 590 6 11386989
  2. [6]Huang B Grant BF Dawson DA Stinson FS Chou SP Saha TD Race-ethnicity and the prevalence and co-occurrence of Diagnostic and Statistical Manual of Mental Disorders, alcohol and drug use disorders and Axis I and II disorders: United States, 2001 to 2002 Compr Psychiatry 2006 47 252 7 16769298
  3. [8]Beckwith H Moran PF Reilly J Personality disorder prevalence in psychiatric outpatients: A systematic literature review Personal Ment Health 2014 8 91 101 24431304
  4. [10]Moran P Jenkins R Tylee A Blizard R Mann A The prevalence of personality disorder among UK primary care attenders Act Psychiatr Scand 2000 102 52 7 10892610
  5. [11]Verheul R Co-morbidity of PD in individuals with substance use disorders Eur Psychiatr 2001 16 274 82 11514129
  6. [12]Walter M Gunderson JG Zanarini MC Sanislow C Grilo CM McGlashan TH New onsets of substance use disorders in borderline personality disorder over seven years of follow-ups Addiction 2009 204 97 103 PMC2743265 19133893
  7. [13]Brooner RK King VL Kidorf M Schmidt CW Bigelow GE Psychiatric and substance use comorbidity among treatment seeking opioid abusers Arch Gen Psychiatry 1997 54 71 80 9006403
  8. [14]Driessen M Veltrup C Wetterling T John U Dilling H Axis I and Axis II comorbidity in alcohol dependence and the two types of alcoholism Alcohol Clin Exp Res 1998 22 77 86 9514288
  9. [15]Kokkevi A Stefanis N Anastasopoulou E Kostogianni C PD in drug abusers: Prevalence and their association with Axis I disorders as predictors of treatment retention Addict Behav 1998 23 841 53 9801720
  10. [16]Morgenstern J Langenbucher J Labouvie E Miller KJ The comorbidity of alcoholism and PD in a clinical population: Prevalence rates and relation to alcohol typology variables J Abnorm Psychol 1997 106 74 84 9103719
  11. [17]Rounsaville BJ Kranzler HR Ball SA Tennen H Poling J Triffleman E PD in substance abusers: Relation to substance use J Nerv Ment Dis 1998 186 87 95 9484308
  12. [18]Landheim AS Bakken K Vaglum P Gender differences in the prevalence of symptom disorders and personality disorders among poly-substance abusers and pure alcoholics Eur Addict Res 2003 9 8 17 12566793
  13. [19]Singh NH Sharma SG Pasweth AM Psychiatric co-morbidity among alcohol dependants Indian J Psychiatry 2005 47 222 4 20711311 PMC2921139
  14. [20]Langås AM Malt UF Opjordsmoen S In-depth study of personality disorders in first-admission patients with substance use disorders BMC Psychiatry 2012 12 180 23107025 PMC3514215
  15. [21]Preuss UW Johann M Fehr C Koller G Wodarz N Hesselbrock V PD in alcohol-dependent individuals: Relationship with alcohol dependence severity Eur Addict Res 2009 15 188 95 19622885 PMC2790737
  16. [23]Trull TJ Jahng S Tomko RL Wood PK Sher KJ Revised NESARC personality disorder diagnoses: Gender, prevalence, and comorbidity with substance dependence disorders J Pers Disord 2010 24 412 26 20695803 PMC3771514
  17. [24]Trull TJ Sher KJ Minks-Brown C Durbin J Burr R Borderline personality disorder and substance use disorders: A review and integration Clin Psyschol Rev 2000 20 235 53 10721499
  18. [27]Dom G Moggi F Co-occurring Addictive and Psychiatric Disorders 2016 Berlin, Heidelberg Springer
  19. [28]Barnes GE The alcoholic personality: A reanalysis of the literature J Stud Alcohol 1979 40 571 634 385996
  20. [30]Belcher AM Volkow ND Moeller FG Ferré S Personality traits and vulnerability or resilience to substance use disorders Trends Cogn Sci 2014 18 211 7 24612993 PMC3972619
  21. [31]Aron AR Behrens TE Smith S Frank MJ Poldrack RA Triangulating a cognitive control network using diffusion-weighted magnetic resonance imaging (MRI) and functional MRI J Neurosci 2007 27 3743 52 17409238 PMC6672420
  22. [32]Aron AR Robbins TW Poldrack RA Inhibition and the right inferior frontal cortex Trends Cogn Sci 2004 8 170 7 15050513
  23. [33]Swann NC Cai W Conner CR Pieters TA Claffey MP George JS Roles for the pre-supplementary motor area and the right inferior frontal gyrus in stopping action: Electrophysiological responses and functional and structural connectivity Neuroimage 2012 59 2860 70 21979383 PMC3322194
  24. [34]Tabibnia G Monterosso JR Baicy K Aron AR Poldrack RA Chakrapani S Different forms of self-control share a neurocognitive substrate J Neurosci 2011 31 4805 10 21451018 PMC3096483
  25. [35]Ersche KD Jones PS Williams GB Turton AJ Robbins TW Bullmore ET Abnormal brain structure implicated in stimulant drug addiction Science 2012 335 601 4 22301321
  26. [37]Cornish KM Manly T Savage R Swanson J Morisano D Butler N Association of the dopamine transporter (DAT1) 10/10-repeat genotype with ADHD symptoms and response inhibition in a general population sample Mol Psychiatry 2005 10 686 98 15809660
  27. [38]González S Rangel-Barajas C Peper M Lorenzo R Moreno E Ciruela F Dopamine D4 receptor, but not the ADHD-associated D4.7 variant, forms functional heteromers with the dopamine D2S receptor in the brain Mol Psychiatry 2012 17 650 62 21844870 PMC3219836
  28. [39]Kang AM Palmatier MA Kidd KK Global variation of a 40-bp VNTR in the 3’-untranslated region of the dopamine transporter gene (SLC6A3) Biol Psychiatry 1999 46 151 60 10418689
  29. [40]Phan KL Fitzgerald DA Nathan PJ Moore GJ Uhde TW Tancer ME Neural substrates for voluntary suppression of negative affect: A functional magnetic resonance imaging study Biol Psychiatry 2005 57 210 9 15691521
  30. [42]Terracciano A Löckenhoff CE Bienvenu OJ Costa PT Crum RM Five-factor model personality profiles of drug users BMC Psychiatry 2008 8 22 18405382 PMC2373294
  31. [43]Kotov R Gamez W Schmidt F Watson D Linking “big” personality traits to anxiety, depressive, and substance use disorders: A meta-analysis Psychol Bull 2010 136 768 821 20804236
  32. [46]Lesch KP Bengel D Heils A Sabol SZ Greenberg BD Petri S Association of anxiety-related traits with a polymorphism in the serotonin transporter gene regulatory region Science 1996 274 1527 31 8929413
  33. [49]Salamone JD Correa M The mysterious motivational functions of mesolimbic dopamine Neuron 2012 76 470 85 23141060 PMC4450094
  34. [50]Baik SH Yoon HS Kim SE Kim SH Extraversion and striatal dopaminergic receptor availability in young adults: An [18F] fallypride PET study Neuroreport 2012 23 251 4 22257904
  35. [51]Volkow ND Wang GJ Begleiter H Porjesz B Fowler JS Telang F High levels of dopamine D2 receptors in unaffected members of alcoholic families: Possible protective factors Arch Gen Psychiatry 2006 63 999 1008 16953002
  36. [52]Volkow ND Wang GJ Fowler JS Tomasi D Telang F Addiction: Beyond dopamine reward circuitry Proc Natl Acad Sci USA 2011 108 15037 42 21402948 PMC3174598
  37. [53]Wills TA DuHamel K Vaccaro D Activity and mood temperament as predictors of adolescent substance use: Test of a self-regulation mediational model J Pers Soc Psychol 1995 68 901 16 7776186
  38. [54]Wills TA Sandy JM Yaeger A Shinar O Family risk factors and adolescent substance use: Moderation effects for temperament dimensions Dev Psychol 2001 37 283 97 11370906
  39. [55]Kienast T Stoffers J Bermpohl F Lieb K Borderline personality disorder and comorbid addiction: Epidemiology and treatment Dtsch Arztebl Int 2014 111 280 6 24791755 PMC4010862
  40. [56]Preuss UW Koller G Barnow S Eikmeier M Soyka M Suicidal behavior in alcohol-dependent subjects: The role of PD Alcohol Clin Exp Res 2006 30 866 77 16634856
  41. [57]Verheul R Van den Brink W Hartgers C PD predict relapse in alcoholic patients Addict Behav 1998 23 869 82 9801722
  42. [58]Wilson ST Fertuck EA Kwitel A Stanley MC Stanley B Impulsivity, suicidality and alcohol use disorders in adolescents and young adults with borderline personality disorder Int J Adolesc Med Health 2006 18 189 96 16639873
  43. [59]Tull MT Gratz KL The impact of borderline personality disorder on residential substance abuse treatment dropout among men Drug Alcohol Depend 2012 121 97 102 21907503 PMC3237890
  44. [60]Krampe H Wagner T Stawicki S Bartels C Aust C Kroener-Herwig B Personality disorder and chronicity of addiction as independent outcome predictors in alcoholism treatment Psychiatr Serv 2006 57 708 12 16675768
  45. [61]Alterman AI Rutherford MJ Cacciola JS McKay JR Boardman CR Prediction of 7 months methadone maintenance treatment response by four measures of antisociality Drug Alcohol Depend 1998 49 217 23 9571386
  46. [62]Cacciola JS Alterman AI Rutherford MJ Alterman AI McKay JR Snider EC PD and treatment outcome in methadone maintenance patients J Nerv Ment Dis 1996 184 234 9 8604033
  47. [63]Cacciola JS Alterman AI Rutherford MJ Snider EC Treatment response of antisocial substance abusers J Nerv Ment Dis 1995 183 166 71 7891063
  48. [64]Cecero JJ Ball SA Tennen H Kranzler HR Rounsaville BJ Concurrent and predictive validity of ASPD subtyping among substance abusers J Nerv Ment Dis 1999 187 478 86 10463065
  49. [65]Crits-Cristoph P Siqueland L Blaine J Frank A Luborsky L Onken LS Psychosocial treatments for cocaine dependence: NIDA collaborative cocaine treatment study Arch Gen Psychiatry 1999 56 493 502 10359461
  50. [66]Fenton MC Keyes K Geier T Greenstein E Skodol A Krueger B Psychiatric comorbidity and the persistence of drug use disorders in the United States Addiction 2012 107 599 609 21883607 PMC3260401
  51. [67]Balhara YP Parmar A Sarkar S Verma R Stigma in dual diagnosis: A narrative review Indian J Soc Psychiatr 2016 32 128 133
  52. [70]van den Bosch LM Verheul R Schippers GM van den Brink W Dialectical behavior therapy of borderline patients with and without substance use problems: Implementation and long-term effects Addict Behav 2002 27 911 23 12369475
  53. [72]Ball SA Cobb-Richardson P Connolly AJ Bujosa CT O’Neall TW Substance abuse and PD in homeless drop-in center clients: Symptom severity and psychotherapy retention in a randomized clinical trial Compr Psychiatry 2005 46 371 9 16122538
  54. [73]Ball SA Comparing individual therapies for personality disordered opioid dependent patients J Pers Disord 2007 21 305 21 17536942
  55. [74]Ball SA Maccarelli LM LaPaglia DM Ostrowski MJ Randomized trial of dual-focused versus single-focused individual therapy for PD and substance dependence J Nerv Ment Dis 2011 199 319 28 21543951 PMC3100211
  56. [75]Gregory RJ Chlebowski S Kang D Remen AL Soderberg MG Stepkovitch J A controlled trial of psychodynamic psychotherapy for co-occurring borderline personality disorder and alcohol use disorder Psychotherapy (Chic) 2008 45 28 41 22122363
  57. [76]Conrod PJ Castellanos-Ryan N Strang J Brief, personality-targeted coping skills interventions and survival as a non-drug user over a 2-year period during adolescence Arch Gen Psychiatry 2010 67 85 93 20048226
  58. [77]Conrod PJ Stewart SH Comeau N Maclean AM Efficacy of cognitive-behavioral interventions targeting personality risk factors for youth alcohol misuse J Clin Child Adolesc Psychol 2006 35 550 63 17007600
  59. [78]Conrod PJ Stewart SH Pihl RO Côté S Fontaine V Dongier M Efficacy of brief coping skills interventions that match different personality profiles of female substance abusers Psychol Addict Behav 2000 14 231 42 10998949
  60. [79]Nordholm D Nielsen B PD among Danish alcoholics attending outpatient treatment Eur Addict Res 2007 13 222 9 17851244
  61. [81]Nielsen P Røjskjær S Hesse M Personality-guided treatment for alcohol dependence: A quasi-randomized experiment Am J Addict 2007 16 357 64 17882606
  62. [82]Parmar A Sarkar S Brief interventions for cannabis use disorders: A review Addict Disord Their Treat 2017 16 80 93
  63. [83]Thylstrup B Hesse M Impulsive lifestyle counseling to prevent dropout from treatment for substance use disorders in people with ASPD: A randomized study Addict Behave 2007 57 48 54 26882500
  64. [84]Thylstrup B Schrøder S Hesse M Psycho-education for substance use and ASPD: A randomized trial BMC Psychiatry 2015 15 283 26573140 PMC4647713
  65. [85]Thylstrup B Schrøder S Fridell M Hesse M Did you get any help? A post-hoc secondary analysis of a randomized controlled trial of psychoeducation for patients with ASPD in outpatient substance abuse treatment programs BMC Psychiatry 2017 17 7 28068951 PMC5223491
  66. [86]Herpertz SC Zanarini M Schulz CS Siever L Lieb K Möller HJ WFSBP task force on PD. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of PD World J Biol Psychiatry 2007 8 212 44 17963189
  67. [87]Ralevski E Ball S Nich C Limoncelli D Petrakis I The impact of PD on alcohol-use outcomes in a pharmacotherapy trial for alcohol dependence and comorbid Axis I disorders Am J Addict 2007 16 443 9 18058408
  68. [88]Kiefer F Jahn H Tarnaske T Helwig H Briken P Holzbach R Comparing and combining naltrexone and acamprosate in relapse prevention of alcoholism: A double-blind, placebo-controlled study Arch Gen Psychiatry 2003 60 92 9 12511176
  69. [89]Gianoli MO Jane JS O’brien E Ralevski E Treatment for comorbid borderline personality disorder and alcohol use disorders: A review of the evidence and future recommendations Exp Clin Psychopharmacol 2012 20 333 44 22686496 PMC3697118
  70. [90]Stuyt EB Ear acupuncture for co-occurring substance abuse and borderline personality disorder: An aid to encourage treatment retention and tobacco cessation Acupunct Med 2014 32 318 24 24824499
  71. [91]Kuppili PP Parmar A Gupta A Balhara YP Role of yoga in management of substance-use disorders: A narrative review J Neurosci Rural Pract 2018 9 117 122 29456355 PMC5812135

Authors
Parmar, A., & Kaloiya, G.
Affiliations
All India Institute of Medical Sciences (IN)
Corresponding author
Parmar, Arpit
ORCID
Parmar, Arpit
Venue
Indian Journal of Psychological Medicine
Publisher
SAGE Publications
Published
2018-11
Volume
40
Issue
6
Pages
517-527
ISSN
  • 0253-7176 (ISSN-L)
  • 0975-1564
DOI
10.4103/ijpsym.ijpsym_164_18
PMC
PMC6241194
OpenAlex
W2908426055
Cited by
93
References
83
Citations by year
2026: 11 · 2025: 11 · 2024: 7 · 2023: 34 · 2022: 13 · 2021: 8 · 2020: 7 · 2019: 2
FWCI
0.72
Type
journal article
Language
en
Open access
Licence
Locations
  • Indian Journal of Psychological Medicine (publishedVersion, cc-by-nc-sa)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-sa)
  • PubMed Central (publishedVersion, cc-by-nc-sa)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Social Sciences › Psychology › Clinical Psychology › Personality Traits and Psychology
Keywords
personality disorders, substance use disorders, comorbidities, borderline personality disorder, antisocial personality disorder, drug use disorders, alcoholism, prevalence, treatment response, prognosis, psychotherapy, dialectical behavior therapy, pharmacotherapy

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