Personality dysfunction among people with opioid dependence and other substance use disorders

Recent debates have questioned the validity of distinct categories of personality disorder and there has been some movement away from a categorical system and toward a dimensional classification of personality dysfunction. This has been driven, in part, from the substantial comorbidity among the 10 personality disorders that suggests a high degree of symptom overlap. At the core of personality disorder is an inability to develop meaningful and satisfactory interpersonal relationships. The DSM-5 Personality and Personality Disorder Work Group had proposed a revised classification based on impairments in self-functioning and interpersonal functioning along with degree of severity across five trait domains – negative affectivity, dissocial, disinhibition, anankastic and detachment.

One population with a high prevalence of personality disorders is people with substance use disorder. Among individuals with opioid dependence specifically, comorbid personality disorder has been associated with greater severity of dependence and poorer treatment outcomes. This study will compare two different screening tools for personality disorder along with measures of interpersonal and social functioning among people accessing opioid substitution therapy. Participants that screen positive for a personality disorder will be invited to participate in an interview to further explore the impact of personality symptoms on general and social functioning, particularly relationships with others including treatment providers. This project has the capacity to support a couple of student projects that, for example, may wish to focus on different sub-populations such as injecting drug users not in treatment or people with problematic alcohol or benzodiazepine use.