Personality Disorders among Psychoactive Substance Users: Diagnostic and Psychodynamic Issues

The treatment programmes for drug addiction operate on a constantly growing population of subjects who have received unsuccessful treatment with various negative consequences, mainly in terms of cost/benefit (due, e.g., to low therapeutic compliance and high rates of early drop-outs). The study we present is the first long-term Italian research project on psychiatric comorbidity carried out using standardised instruments. The sample consisted of 606 opioid addicts divided into two subgroups according to the type of treatment unit they were referred to (36.8% started residential programmes and 63.2% received outpatient treatment). Diagnostic evaluation consisted of a semi-structured interview that outlined the psychopathological profile according to DSM III. Only 323 subjects were recruited and included in the follow-up study (18-36 months after the end of treatment, either completed or interrupted). Our preliminary results tend to confirm international data, both in terms of rates and disorders. An analysis of the correlation between the clusters of personality disorders and the attrition/retention rates in different treatments shows that substance users with a diagnosis in cluster B tend to prefer outpatient treatment. When outcome was considered, we always found that subjects with a diagnosis of personality disorder showed a better response to residential than to outpatient treatment. © 1996 S. Karger AG, Basel.