Co-occurence of Substance Use and Personality Disorders: Epidemiology, Etiopathogenesis, and Treatment

A recent population study has shown that among people manifesting a disorder related to alcohol and other substances, 28.6% and 47.7% respectively had at least one personality disorder (PD). Numerous sample studies have highlighted the presence of PDs in the drug-addicted population, estimating prevalence rates ranging from 44% to 79%. The most frequent PDs in the clinical sample were antisocial, borderline, avoidant, and paranoid PDs. Various types of relationship between addiction and PDs can be hypothesized: a common etiology (biological or psychic), an etiological relationship (predisposed personality or self-medication hypothesis), or one that is influenced reciprocally. PD comorbidity is associated with a spectrum of substance-correlated disorders, which are more chronic and severe and require many long-term therapeutic programs. Various psychotherapeutic treatments have proven to be efficacious with respect to reducing personality pathology and improving social functioning. This is especially true for cognitive-behaviorally or psychodynamically oriented individual psychotherapies. Considering the models of services organization, dual diagnosis patients can be better treated by using an integrated model with approaches that bridge the gap between the psychiatric and addiction services.