title: Personality disorders and the 3-year course of alcohol, drug, and nicotine use disorders.
abstract: BACKGROUND
  Little is known about the role of a broad range of personality disorders in the course of substance use disorder (SUD) and whether these differ by substance. The existing literature focuses mostly on antisocial personality disorder and does not come to clear conclusions.
  
  
  OBJECTIVE
  To determine the association between the 10 DSM-IV personality disorders and the persistence of common SUDs in a 3-year prospective study of a national sample.
  
  
  METHODS
  Data were drawn from participants in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) who had alcohol dependence (n = 1172), cannabis use disorder (n = 454), or nicotine dependence (n = 4017) at baseline and who were reinterviewed 3 years later. Control variables included demographic characteristics, family history of substance disorders, baseline Axis I disorders and treatment status, and prior SUD duration. Main Outcome Measure  Persistent SUD, defined as meeting full criteria for the relevant SUD throughout the 3-year follow-up period.
  
  
  RESULTS
  Persistent SUD was found among 30.1% of participants with alcohol dependence, 30.8% with cannabis use disorder, and 56.6% with nicotine dependence at baseline. Axis I disorders did not have strong or consistent associations with persistent SUD. In contrast, antisocial personality disorder was significantly associated with persistent alcohol, cannabis, and nicotine use disorders (adjusted odds ratios, 2.46-3.51), as was borderline personality disorder (adjusted odds ratios, 2.04-2.78) and schizotypal personality disorder (adjusted odds ratios, 1.65-5.90). Narcissistic, schizoid, and obsessive-compulsive personality disorders were less consistently associated with SUD persistence.
  
  
  CONCLUSIONS
  The consistent findings on the association of antisocial, borderline, and schizotypal personality disorders with persistent SUD indicates the importance of these personality disorders in understanding the course of SUD. Future studies should examine dimensional representations of personality disorders and the role of specific components of these disorders, biological and environmental contributors to these relationships, and potential applications of these findings to treatment development.
authors: Department of Psychiatry, College of Physicians and Surgeons, Columbia University, NY 10032, USA. dsh2@columbia.edu
authors: Deborah
authors: D
authors: Hasin
authors: Miriam C
authors: MC
authors: Fenton
authors: Andrew
authors: A
authors: Skodol
authors: Robert
authors: R
authors: Krueger
authors: Katherine
authors: K
authors: Keyes
authors: Timothy
authors: T
authors: Geier
authors: Eliana
authors: E
authors: Greenstein
authors: Carlos
authors: C
authors: Blanco
authors: Bridget
authors: B
authors: Grant
mesh_terms: D000293:Adolescent; D000328:Adult; D000437:Alcoholism / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D015897:Comorbidity; D003710:Demography; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D008875:Middle Aged; D010554:Personality Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D018570:Risk Assessment; D012959:Socioeconomic Factors; D014029:Tobacco Use Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology