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Am J Psychiatry 1991; 148:118-120
Copyright © 1991 by American Psychiatric Association
Axis II comorbidity in substance abusers
EP Nace, CW Davis and JP Gaspari
Timberlawn Psychiatric Hospital, Dallas, TX 75223.
OBJECTIVE: To assess the complex relationship between substance abuse and
personality disorders, the authors determined the prevalence of personality
disorders in a group of middle-class substance abusers and compared the
subjects who had personality disorders with those who did not. METHOD: The
subjects were drawn from patients consecutively admitted to an inpatient
substance abuse program in a private psychiatric hospital; they were the
first 100 who agreed to participate. Substance dependence was diagnosed
according to DSM-III-R, and the patients were assessed with the Structured
Clinical Interview for DSM-III-R Personality Disorders, Alcohol Use
Inventory, MMPI, Health and Daily Living Form, Shipley Institute of Living
Scale, and measures of chemical use and life satisfaction. RESULTS: Of the
100 substance abusers, 57 had personality disorders. These patients
differed significantly from the 43 patients without personality disorders
in several ways: they had greater involvement with illegal drugs, had
different patterns of alcohol use, had greater psychopathology, were less
satisfied with their lives, and were more impulsive, isolated, and
depressed. CONCLUSIONS: Because of the marked differences between the
substance abusers with and without personality disorders, a uniform
approach to substance abuse treatment may be inadequate.
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