Prevalence and correlates of personality disorder diagnoses among cocaine dependent outpatients

This paper reports on the prevalence and the pretreatment psychiatric, drug use, and demographic correlates of DSM-III-R personality disorders (PD) in a sample of 289 cocaine dependent outpatients accepted into the pilot phase of a randomized, multisite, clinical trial comparing different psychotherapy and drug counseling treatment modalities. Diagnoses were established using the SCID, administered to patients after a brief drug free period by highly experienced evaluators. Results showed that 48% of the patients had at least one PD and 18% had two or more. Of those with a PD, 65% had a Cluster B disorder with antisocial (APD) and borderline (BPD) PD being the most common. Men were significantly more likely to be diagnosed with APD than women, but no other gender differences were found. Patients with PDs were significantly more likely to receive another Axis 1 diagnosis and to have more severe psychiatric symptoms than patients without PDs. However, the groups did not differ on other measures of drug use severity or demographic variables, Additional subgroup analyses showed that patients with comorbid BPD had the highest level of depression, and patients who had both APD and BPD were more functionally impaired than patients with no PD. While the prognostic significance of these findings remains unclear, the results suggest that personality disorders are apt to play an important role in the treatment of cocaine dependence, and should be incorporated into the development of future treatments and research studies.