Levinson, Carolyn

Nich, Charla

Petrakis, Ismene

Poling, James

Ralevski, Elizabeth

Rounsaville, Bruce

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Washington University School of MedicineDigital Commons@BeckerPosters 2005: Alcoholism and Comorbidity2005Personality disorders as predictors of treatmentoutcome in a sample of alcohol dependent veteranswith comorbid axis I disordersElizabeth RalevskiBruce RounsavilleJames PolingCharla NichCarolyn LevinsonSee next page for additional authorsFollow this and additional works at: http://digitalcommons.wustl.edu/guzeposter2005Part of the Medicine and Health Sciences CommonsThis Poster is brought to you for free and open access by the 2005: Alcoholism and Comorbidity at Digital Commons@Becker. It has been accepted forinclusion in Posters by an authorized administrator of Digital Commons@Becker. For more information, please contact engeszer@wustl.edu.Recommended CitationRalevski, Elizabeth; Rounsaville, Bruce; Poling, James; Nich, Charla; Levinson, Carolyn; and Petrakis, Ismene, "Personality disordersas predictors of treatment outcome in a sample of alcohol dependent veterans with comorbid axis I disorders" (2005). Posters. Paper12 Samuel B. Guze Symposium on Alcoholism.http://digitalcommons.wustl.edu/guzeposter2005/12AuthorsElizabeth Ralevski, Bruce Rounsaville, James Poling, Charla Nich, Carolyn Levinson, and Ismene PetrakisThis poster is available at Digital Commons@Becker: http://digitalcommons.wustl.edu/guzeposter2005/12PERSONALITY DISORDERS AS PREDICTORS OF TREATMENT OUTCOME IN A SAMPLE OF ALCOHOL DEPENDENT VETERANS WITH COMORBID AXIS I DISORDERSElizabeth Ralevski PhD, Bruce Rounsaville MD, James Poling PhD,Charla Nich, Carolyn Levinson,Ismene Petrakis MDThis study was supported by Veterans Affairs VISN I Mental Illness Research Education Clinical Center (MIRECC), VA Merit Review Grant, Stanley Research Foundation GrantBackgroundAntisocial personality disorder (ASPD) and Borderline personality disorder (BPD) are most frequently diagnosed Axis II disorders among substance abusers• Rates vary from 25% to 75%• Patients with ASPD and BPD have worse treatment outcomesSeveral problems with research in this area• Studies comparing patients with ASPD or BPD are sparse • The mediating role of ASPD and BPD is poorly understood• What is the frequency of BPD and ASPD in dually diagnosed (substance abuse and Axis I disorders)?HypothesisSpecific Aim 1: To examine the rates of Axis II disorders in dually diagnosed veterans who participated in a clinical trial • What are the rates of ASPD and BPD among dually diagnosed patients?• What is the distribution of Axis I disorders in patients with ASPD versus BPD?Specific Aim 2: To investigate the effect of personality on treatment variables and outcome• Are patients with ASPD or BPD less likely to respond to treatment than patients with no diagnosis of ASPD or BPD?• Will patients with ASPD or BPD exhibit more significant alcohol and psychiatric pathology - measured by various scales – than patients with no diagnosis of ASPD or BPD?SUBJECTS• 225 veterans• Inclusion Criteria– Age 18-60– Axis I Psychiatric Disorder– Alcohol Dependence and recent drinking (past 30 days)• Exclusion Criteria– Current opiate dependence or treatment with opioid medication– Significant underlying medical issues– Psychiatric instabilityStudy Design• 12 week outpatient study• Patients were assigned to 1 of 4 treatment groups (naltexone, placebo, disulfiram & placebo, and disulfiram & naltrexone)• Axis I and Axis II disorders were assessed at baseline• Outcome measures were administered at baseline and weeklyMeasures• Structured Clinical Interview for DSM-IV Axis I (SCID I)• Structured Clinical Interview for DSM-IV Axis II (SCID II) ASPD and BPD diagnoses only• Primary Treatment Outcomes – Alcohol use & craving ¾Time Line Follow Back (TLFB), Obsessive Compulsive Drinking Scale (OCDS)• Secondary Treatment Outcomes– Psychiatric symptoms ¾Brief Symptom Inventory (BSI) Demographic CharacteristicsASPD+BPD(n=42)ASPD(n=54)BPD(n=26)Neither PD*(n=103)Age  (years) 43.5 (8.4) 44.3 (5.9) 49.3 (9.3) 49.1 (8.5)Gender (male) 40 (95%) 54 (100%) 26 (100%) 99 (96%)Caucasian 29 (69%) 41(76%) 19 (73%) 77 (75%)Not Married 11 (26%) 19 (35%) 7 (27%) 19 (18%)Employed full-time 18 (43%) 32 (59%) 15 (58%) 52 (50%)Skilled work 10 (24%) 28 (52%) 5 (19%) 24 (23%)Education  (years) 12.7 (1.6) 12.6 (1.5) 13.1 (2.1) 13.1 (2.1)* Personality Disorder (PD)Rates of Axis I disorders in patients with and without personality disordersASPD+BPD(n=42)ASPD(n=54)BPD(n=26)Neither PD (n=103)Axis I diagnosesMajor Depression* 27 (64%) 33 (61%) 16 (62%) 52 (50%)PTSD 15 (36%) 23 (50%) 13 (50%) 35 (34%)Cocaine dependence* 9 (21%) 19 (35%) 6 (23%) 8 (8%)Opioid dependenceLifetime*12 (29%) 7 (13%) 5 (19%) 7 (7%)*Significantly different, p<0.05Alcohol outcome measures for patients with and without personality disordersASPD+BPD(n=42)ASPD(n=54)BPD(n=26)Neither PD(n=103)MeasuresTotal heavy drinking days2.1 (6.1) 3.4 (7.7) 4.0 (10.5) 3.9 (9.8)Mean drinking days per week .21 (.57) .33 (.77) .56 (1.1) .41 (.91)% days with any drinks3% 5% 8% 5%Mean # drinks per drinking day 13.4 (10.3) 19.7 (17.7) 19.0 (13.0) 13.8 (13.4)Consecutive weeks of abstinence 9.9 (3.5) 9.1 (3.9) 6.7 (5.1)* 9.4 (3.7)* Significantly different, p=0.002BSI: Hostility scores for patients with and without personality disorders00.20.40.60.811.20 1 2 3 4 5 6 7 8 9 10 11 12ASPD+BPDASPDBPDNeither PDSignificant time x diagnosis interaction p=.0001BSI: Paranoid ideation scores for patients with and without personality disorders00.20.40.60.811.21.41.60 1 2 3 4 5 6 7 8 9 10 11 12ASPD+BPDASPDBPDNeither PDSignificant time x diagnosis interaction p=0.000100.20.40.60.811.21.41.60 1 2 3 4 5 6 7 8 9 10 11 12ASPD+BPDASPDBPDNeither PDObsessive compulsive scores for  patients with and without personality disordersSignificant time x diagnosis interaction p=0.003Summary• Rates of ASPD are higher than rates of BPD among dually diagnosed patients• Rates of major depression, lifetime opiate dependence and current cocaine dependence are higher among patients with these Personality Disorder (PD) than patients without • BPD patients had fewer weeks of abstinence compared to the other groups• Patients with diagnoses of both ASPD and BPD tend to be more hostile, paranoid and have more obsessive thought than patients with neither PD diagnosis or a single PD diagnosisConclusions• Rates of ASPD and BPD in a dually diagnosed patients are compatible with rates in other studies with alcohol dependent patients• Patients with ASPD and BPD are at a higher risk for abusing other substances• Diagnosis of BPD may have implication for alcohol relapse• Patients with more than one PD exhibit more significant pathology than patients with ASPD alone, BPD alone or neither PD diagnosisThis study was supported by 

Personality disorders as predictors of treatment outcome in a sample of alcohol dependent veterans with comorbid axis I disorders

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Personality disorders as predictors of treatment outcome in a sample of alcohol dependent veterans with comorbid axis I disorders

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