Birds of a Feather Flock Together: Concurrent Personality Disorders and Substance Use Disorders
Bibliographic record
Abstract
ABSTRACT Personality disorders (PDs) and substance use disorders (SUDs) have a long history of being recognized as intimately linked, sharing many common clinical features, and frequently co-occurring in individuals seeking treatment for 1 or the other disorder. Equally important, it has long been recognized that the presence of 1 disorder has a significant and negative impact on the prognosis of the other disorder. Individuals with concurrent PD and SUD typically have worse addiction severity and greater impairment in functioning. Clinicians’ inability or reluctance to accurately diagnose PDs in a timely manner in SUD patients may inadvertently have a negative impact on their recovery and clinical prognosis. Individuals with concurrent PD and SUD have been observed to present with greater severity of symptoms, to be more resistant to treatment, and have an increased risk of relapse. Unfortunately, despite the significant prevalence of concurrent PDs and SUDs, there is a scarcity of evidence-based treatment approaches for this population. Ideally, these individuals would be offered highly structured integrative care and evidence-based relapse prevention pharmacotherapy for addictive disorders, as there is very limited effective pharmacotherapy for PDs. This article explores the interface between SUDs and PDs, attempting to highlight the complex interaction of the respective disorders and how this might inform treatment choices, specifically the need for comprehensive approaches for patients suffering from PDs and addiction, a population who tend to be stigmatized and marginalized. Les troubles de la personnalité (TP) et les troubles liés à l’utilisation de substances (TUS) sont reconnus depuis longtemps comme étant intimement liés, partageant de nombreuses caractéristiques cliniques communes et coexistant fréquemment chez les personnes cherchant un traitement pour l’un ou l’autre trouble. Tout aussi important, il est reconnu depuis longtemps que la présence d’un trouble a un impact significatif et négatif sur le pronostic de l’autre trouble. Les personnes atteintes de TP et de TUS simultanées ont généralement une plus grande gravité de l’addiction et une plus grande altération du fonctionnement. L’incapacité ou la réticence des cliniciens à diagnostiquer avec précision les TP en temps opportun chez les patients souffrant de TUS peut avoir par inadvertance un impact négatif sur leur rétablissement et leur pronostic clinique. Il a été observé que les personnes atteintes de TP et de TUS simultanées présentaient des symptômes plus graves, étaient plus résistantes au traitement et avaient un risque accru de rechute. Malheureusement, malgré la prévalence importante des TP et des TUS concomitants, il existe une pénurie d’approches thérapeutiques fondées sur des traitements ayant fait leur preuves pour cette population. Idéalement, ces personnes se verraient offrir des soins intégrés hautement structurés et une pharmacothérapie de prévention des rechutes fondée sur des traitements ayant fait leur preuves pour les troubles de dépendance, car il existe très peu de pharmacothérapie efficace pour les troubles de la personnalité. Cet article explore l’interface entre les TUS et les TP, essayant de mettre en évidence l’interaction complexe des troubles respectifs et comment cela pourrait éclairer les choix de traitement, en particulier le besoin d’approches globales pour les patients souffrant de TP et d’addiction, une population qui a tendance à être stigmatisée et marginalisée.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".