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Research and Advances in Psychiatry

Change in personality over time according to the Drug-of-Choice: a longitudinal study in a community-based treatment program for drug abusers

Original Article, 28 - 37
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Introduction: The relation between personality disorders (PD) and substance-use disorders (SUD) is a topic of growing interest. Comorbidity of PDs with SUDs has important clinical implication in term of treatment, such as resistance and premature discontinuation of rehabilitation programs.
Very limited data are available on change in specific personality dimensions over time depending on the Drug of Abuse.
Aim of the study: The aim of the present study is to investigate changes over time in personality dimensions in a community-based treatment program for drug abusers according to the Drug-of- Choice.
Methods: This is a 1-year follow-up observational study. Patients from a rehabilitation community in Sardinia, Italy, were consecutively recruited. Millon-Clinical-Multiaxial-Inventory-III (MCMI-III) was performed at baseline (the entry at the therapeutic community treatment) and at 1 year of follow-up.
Patients were stratified according to the Drug-of-Choice in 4 groups: Cocaine, Heroin, Alcohol and Cannabis abusers. Paired T-Student test was applied for quantitative variables in T0 and T1, with significant level at 0.05.
Results: A total of 147 patients was assessed at baseline, with 55 drop-outs (38.7%) before 1 year of treatment. The final sample consisted in 87 patients, 76 men (87.4%) and 11 women (12.6%). Mean age of the participants was 36 years (sd = 9.1 years) with mean age at onset of substance abuse of 20.3 (sd = 7.7). In the final sample the 4 groups according to the Drug-of-Choice were: 20 (23%) for cocaine, 31 (35.6%) for heroine, 26 (29.9%) for alcohol and 10 (11.5%) for cannabis.
Cocaine addicts showed significant reduction over time in Antisocial (p=0.030) and increase in Obsessive-Compulsive (p=0.001) personality disorders scores. Heroin addicts showed a significant reduction in Schizoid (p=0.006), Avoidant (p=0.001), Depressive (p=0.004), Antisocial (p=0.050), Negativistic (p=0.016), Masochistic (p=0.047), Borderline (p=0.008), Paranoid (p=0.045) scores. A statistical increase in Histrionic (p=0.034) and Obsessive-Compulsive (p=0.027) personality scores was detected at follow-up. Alcohol addicts showed a reduction in Schizoid (p<0.001), Avoidant (p=0.001), Depressive (p=0.001), Dependent (p=0.034), Negativistic (p=0.002), Paranoid (p=0.011) and Schizotypal (p 0.002) personality scores. Also in alcohol group a significant increase in Histrionic (p=0.010) and Compulsive (p=0.029) personality scores was observed. Cannabis addicts showed a significant reduction in Schizoid (p=0.024) and Dependent (p=0.019) personality scores.
Conclusions: These results show how personality changes in drug abusers significantly differ depending on the drug-of-choice. Narcissistic PD did not change over time both for the total sample and in any group. Cocaine and Cannabis addicts appear the most treatment-resistant groups across different personality dimensions, while Heroine and Alcohol addicts showed changes in the majority of PD.