The effects of drug dependence on social systems has helped shape the generally held view that drug dependence is primarily a social problem, not a health problem. In turn, medical approaches to prevention and treatment are lacking. We examined evidence that drug (including alcohol) dependence is a chronic medical illness. A literature review compared the diagnoses, heritability, etiology (genetic and environmental factors), pathophysiology, and response to treatments (adherence and relapse) of drug dependence vs type 2 diabetes mellitus, hypertension, and asthma. Genetic heritability, personal choice, and environmental factors are comparably involved in the etiology and course of all of these disorders. Drug dependence produces significant and lasting changes in brain chemistry and function. Effective medications are available for treating nicotine, alcohol, and opiate dependence but not stimulant or marijuana dependence. Medication adherence and relapse rates are similar across these illnesses. Drug dependence generally has been treated as if it were an acute illness. Review results suggest that long-term care strategies of medication management and continued monitoring produce lasting benefits. Drug dependence should be insured, treated, and evaluated like other chronic illnesses.

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Drug Dependence, a Chronic Medical Illness: Implications for Treatment, Insurance, and Outcomes Evaluation

This chapter reviews recent (2000–2005) personality disorder (PD) research, focusing on three major domains: assessment, comorbidity, and stability. (a) Substantial evidence has accrued favoring dimensional over categorical conceptualization of PD, and the five-factor model of personality is prominent as an integrating framework. Future directions include assessing dysfunction separately from traits and learning to utilize collateral information. (b) To address the pervasiveness and extent of comorbidity, researchers have begun to move beyond studying overlapping pairs or small sets of disorders and are developing broader, more integrated common-factor models that cross the Axis I–Axis II boundary. (c) Studies of PD stability have converged on the finding that PD features include both more acute, dysfunctional behaviors that resolve in relatively short periods, and maladaptive temperamental traits that are relatively more stable—similar to normal-range personality traits—with increasing stability ...

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Assessment and Diagnosis of Personality Disorder: Perennial Issues and an Emerging Reconceptualization

Personality and psychopathology long have been viewed as related domains, but the precise nature of their relations remains unclear. Through most of the 20th century, they were studied as separate fields; within psychopathology, clinical syndromes were separated from personality disorders in 1980. This division led to the revelation of substantial overlap among disorders both within and across axes and to the joint study of normal and abnormal personality. The author reviews these literatures and proposes an integrative framework to explain personality-psychopathology relations: Three broad, innate temperament dimensions--negative affectivity, positive affectivity, and disinhibition--differentiate through both biologically and environmentally based developmental processes into a hierarchical personality trait structure and, at their extremes, are risk factors (diatheses) for psychopathology, especially given adverse life experiences (stress).

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Temperament as a unifying basis for personality and psychopathology.

Overview of 1-year follow-up outcomes in the Drug Abuse Treatment Outcome Study (DATOS).

A conceptual framework for transferring research to practice.

The relationship of counseling and self-help participation to patient outcomes in DATOS.

Substance users have high prevalence rates of disorders that encompass multiple comorbidities, as well as varied substance use and dependence patterns. Prevalence rates of DSM-III-R antisocial personality (ASP) and other comorbid disorders were investigated among a large sample of substance-dependent treatment clients participating in a national, multisite, prospective study of substance users admitted to treatment. Subjects included 7402 substance-dependent clients with an approximate demographic makeup of 66% male, 47% African American, 12% Hispanic, and average age of 32.6 years. Subjects were assessed with modules for substance dependence and for ASP, depressive, and anxiety disorders from the Composite International Diagnostic Interview and the Diagnostic Interview Schedule. Prevalence rates for substance-dependent subjects were 39.3% ASP and 13.9% lifetime Axis I disorders, and these rates differed according to drug-dependency patterns. Logistic regression was used to assess differences among seven ...

Comorbidity of Antisocial Personality and Mood Disorders among Psychoactive Substance-Dependent Treatment Clients

Los consumidores de sustancias presentan elevadas tasas de prevalencia de trastornos que comprenden multiples comorbilidades, asi como varios patrones de consumo y dependencia de substancias. Se estudio las tasas de prevalencia DSM-III-R del trastorno de personalidad antisocial (TPAS) y de otros trastornos comorbidos entre una gran muestra de pacientes en tratamiento por dependencia de sustancias que participaba en un estudio prospectivo, nacional, multicentrico, de consumidores de sustancias admitidos a tratamiento. La muestra incluia 7.402 pacientes dependientes de sustancias, cuya composicion demografica fue 66% varones, 47% afroamericanos, 12% hispanos, y una edad media de 32.6 anos. Se evaluo a los sujetos con los modulos para la dependencia de sustancias, el TPAS, los trastornos depresivos y los de ansiedad, de la entrevista diagnostica �Composite International Diagnostic Interview� y la entrevista �Diagnostic Interview Schedule�. Las tasas de prevalencia observadas en los sujetos con dependencia a sustancias fueron un 39.3% de TPAS y un 13.9% de trastornos del Eje I a lo largo de la vida, hallandose diferencias en dichas tasas segun los patrones de dependencia a las drogas. Se utilizo la regresion logistica para evaluar las diferencias entre siete grupos de dependencia a drogas controlando las diferencias entre edad, sexo y raza/etnia. 
Las interrelaciones entre el TPAS, otros trastornos comorbidos y los patrones de dependencia a la droga fueron evidentes e indicativos de la necesidad de utilizar modelos multivariantes para entender mejor las consecuencias de estas disfunciones comorbidas.

Comorbilidad del trastorno de personalidad antisocial y de los trastornos del estado de ánimo en pacientes con tratamiento por dependencia a sustancias psicoactivas.

S. Gail Craddock

Papers

The relationship of counseling and self-help participation to patient outcomes in DATOS.

Comorbidity of Antisocial Personality and Mood Disorders among Psychoactive Substance-Dependent Treatment Clients

Comorbilidad del trastorno de personalidad antisocial y de los trastornos del estado de ánimo en pacientes con tratamiento por dependencia a sustancias psicoactivas.

Issues in the Assessment of Multiple Drug Use Among Drug Treatment Clients: (496852006-004)

Treatment Outcome Prospective Study (TOPS): Client Characteristics and Behaviors Before, During, and After Treatment: (497002006-006)