Co-Occurrence of 12-Month Alcohol and Drug Use Disorders and Personality Disorders in the United States: Results From the National Epidemiologic Survey on Alcohol and Related Conditions

BACKGROUND: Very little information is available on the co-occurrence of different personality disorders (PDs) and alcohol and drug use disorders in the U.S. population. OBJECTIVE: To present national data on sex differences in the co-occurrence of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM–IV) alcohol and drug use disorders and 7 of the 10 DSM–IV PDs. DESIGN: Face-to-face interviews conducted in the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (N = 43,093). SETTING: The United States and the District of Columbia, including Alaska and Hawaii. PARTICIPANTS: Household and group-quarters residents, age 18 and older. RESULTS: Among individuals with a current alcohol use disorder, 28.6 percent (95 percent confidence interval [CI], 26.7–30.6) had at least one PD, whereas 47.7 percent (95 percent CI, 43.9–51.6) of those with a current drug use disorder had at least one PD. Further, 16.4 percent (95 percent CI, 15.1–17.6) of individuals with at least one PD had a current alcohol use disorder, and 6.5 percent (95 percent CI, 5.7–7.3) had a current drug use disorder. Associations between PDs and alcohol and drug use disorders were overwhelmingly positive and significant (P < .05). Overall, alcohol use disorders were most strongly related to antisocial (odds ratio [OR], 4.8; 95 percent CI, 4.1–5.6), histrionic (OR, 4.7; 95 percent CI 3.8–5.8), and dependent (OR, 3.0; 95 percent CI, 1.9–4.8) PDs. Drug use disorders also were more highly associated with antisocial (OR, 11.8; 95 percent CI, 9.7–14.3), histrionic (OR, 8.0; 95 percent CI, 6.0–10.7), and dependent (OR, 11.6; 95 percent CI, 7.1–19.1) PDs. Associations between obsessive-compulsive, histrionic, schizoid, and antisocial PDs and specific alcohol and drug use disorders were significantly stronger (P < .04) among women than men, whereas the association between dependent PD and drug dependence was significantly greater (P < .04) among men than women. CONCLUSIONS: The co-occurrence of PDs with alcohol and drug use disorders is pervasive in the U.S. population. Results highlight the need for further research on the underlying structure of these disorders and the treatment implications of these disorders when comorbid.