The role of antisocial and borderline personality features in substance dependence among ...

15 Pages·2007·0.18 MB·English

AddictiveBehaviors 32(2007) 1131–1145
The role of antisocial and borderline personality features in
substance dependence among incarcerated females
⁎
Alexander L. Chapman a, , Tony Cellucci b
aDepartment of Psychology (RCB5246), SimonFraserUniversity,8888University Drive, Burnaby,BC,Canada V5A1S6
bDepartment of Psychology,IdahoState University, Pocatello,ID 83201-8112,USA
Abstract
This study examined the association of borderline personality disorder (BPD) and antisocial personality
disorder(ASPD)withsubstancedependenceamongincarceratedfemales(N=105)aswellastheinfluenceofthe
co-occurrenceofBPDandASPDonpsychosocialfunctioninginsubstance-dependentparticipants.Theseverityof
BPD and ASPD both were associated with drug dependence, but BPD was not associated with alcohol
dependence. After controlling for ASPD severity, BPD severity was no longer associated with dug dependence.
The ASPD features of criminal activity and recklessness were most uniquely associated with drug and alcohol
dependence (respectively). None of the BPD features was uniquely associated with alcohol or drug dependence
aftercontrollingforASPD.Aco-occurringBPDdiagnosiswasassociatedwithmooddisturbanceandexperiential
avoidanceamongsubstance-dependentparticipants.AnASPDdiagnosiswasassociatedwithanearlierageatfirst
arrest, along with greater childhood abuse and severity of alcohol dependence. These findings have important
implications for further understanding and developing ways to help substance-dependent incarcerated females.
© 2006 Elsevier Ltd. All rights reserved.
Keywords: Substance dependence;Personality disorders; Borderline; Antisocial; Co-occurring disorders
1. Introduction
Personalitydisorders(PDs)generallyareassociatedwithpoorerpsychosocialfunctioningandinterfere
withthetreatmentofsubstanceusedisorders(SUDs)(Reich&Green,1991;Thomas,Melchert,&Banken,
1999), defined in the present report as alcohol and/or drug dependence. For instance, substance-abusing
patients with a co-occurring PD report significantly greater depression and behavioral dyscontrol, are at
⁎
Correspondingauthor.Tel.:[phone];fax:[phone].
E-mailaddress:[email protected](A.L.Chapman).
0306-4603/$- seefront matter© 2006Elsevier Ltd. All rightsreserved.
doi:10.1016/j.addbeh.2006.08.001
1132 A.L.Chapman, T.Cellucci / AddictiveBehaviors32(2007)1131–1145
greater risk for HIV infection, and are more extensively involved in substance abuse, compared with
substance-abusingpatientswithoutaPD(Nace,Saxon,&Shore,1983;Rutherford,Cacciola,&Alterman,
1994). In particular, borderline personality disorder (BPD) and antisocial personality disorder (ASPD)
commonlyco-occurwithSUDs.Thus,researchisneededtodeterminetheroleofASPDandBPDinSUDs.
Studies have found that BPD and SUD are among the most commonly co-occurring disorders
(McGlashan,Grilo,&Skodol,2000;Verheuletal.,2000).Intheirreview,Trullandcolleaguesreportedthat,
acrossstudies,27%ofsubstanceabusepatientsmetcriteriaforBPD.Moreover,approximatelyhalf(49%)of
BPDpatientsmetcriteriaforanalcoholusedisorderand38%metcriteriaforadrugusedisorder(Trull,Sher,
Minks-Brown, Durbin, & Burr, 2000). Antisocial personality disorder (ASPD) also commonly co-occurs
withSUDs(Hartford&Parker,1994;Lewis&Bucholz,1991),withmanyofthedefiningfeaturesofASPD
involvingbehaviorsfrequentlyseenamongSUDpopulations(e.g.,stealingandotherantisocialacts).
A handful of studies have examined the relationship of specific personality disorder features with
substancedependence.UsinglatentclusteranalysisofASPDsymptomdatafromtheCollaborativeStudy
on Genetics of Alcoholism (COGA), Bucholz, Hesselbrock, Heath, Kramer, and Schuckit (2000)
examinedtheassociationofsubtypesofASPDwithalcoholdependence.Forty-onepercentofthewomen
inthesamplemetcriteriaforalcoholdependence;approximately4%metcriteriaforASPD.Thecluster
identifiedashavingthemostsevereASPDfeaturesalsohadthehighestlevelofdependencesymptoms.
Within this cluster, the most frequently endorsed ASPD features included stealing, illegal activities,
fighting, and defaulting on debts. In one study (Dulit, Fyer, Haas, Sullivan, & Frances, 1990), SUD
patientswhocontinuedtomeetcriteriaforBPDafterexcludingthecontributionofsubstanceabusetothe
diagnosismorefrequentlyreportedthefollowingBPD-relatedfeatures(comparedwithSUDpatientswho
no longer met BPD criteria after excluding the contribution of substance abuse): impulsivity, identity
disturbance, intolerance of being alone, and feelings of emptiness and boredom.
Giventhesubstantialco-occurrenceofSUDwithASPDandBPD,furtherresearchisneededtoexamine
theassociationofspecificPDfeatureswithsubstancedependence.IlluminatingtheassociationbetweenPD
features in SUD may clarify the potential role of PDs in substance use problems. Further clarifying this
relationshipisanimportantstepintheconceptualizationanddevelopmentoftreatmentsforpersonswithco-
occurringPDsandSUDs.
Thepresentstudyfocusedonanincarceratedfemalepopulation.Previousresearchhasindicatedhigh
ratesofpersonalitydisordersamongincarceratedfemales,withratesofBPDandASPDbeingparticularly
high (Chapman, Specht, & Cellucci, 2005a). Incarcerated women increasingly are imprisoned for
substance abuse offenses (Henderson, 1998), and there is some evidence that BPD and ASPD features
maybemorestronglyrelatedtosubstanceuseproblemsinwomenthaninmen(Lewis&Bucholz,1991).
Yet, women with substance use problems remain understudied. For assessment and treatment of
incarcerated women to progress, studies must examine the interplay between SUD and PDs.
The primary purposes of the present study were to (a) examine the association of BPD and ASPD and
specificfeaturesofthesePDswithalcoholanddrugdependenceinincarceratedfemales,and(b)examinethe
effects of ASPD and BPD diagnoses on theoretically relevant aspects of psychosocial functioning among
substance-dependentincarceratedfemales.Inconductingouranalyses,wecontrolledfortheeffectsofBPD
andASPDfeaturesthatarepartiallydependentonthepresenceofsubstanceusebehavior.Wealsocontrolled
fortherespectivePDsinallrelevantanalysesinordertoisolatetheeffectsofBPDandASPD.Wehypothesized
that the severity of BPD and ASPD would be positively associated with the severity of alcohol and drug
dependence. In addition, we speculated that the effects of BPD and BPD features may not be uniquely
associatedwithalcoholanddrugdependenceaftercontrollingfortheseverityofASPD.
A.L. Chapman,T.Cellucci /AddictiveBehaviors 32(2007)1131–1145 1133
We also examined the effects of co-occurring BPD or ASPD on psychosocial functioning among
substance-dependent incarcerated females in the following domains: chronicity of legal difficulties,
experiential avoidance, childhood abuse, depression and hopelessness, and drug and alcohol dependence
severity.AnearlystudybasedontheEpidemiologicalCatchmentArea(ECA)data(Lewis&Bucholz,1991)
foundthatASPDwasuniquelyassociatedwithcurrentalcoholproblemsaftercontrollingforfamilyhistory
ofalcoholproblems.Anotherstudyfoundthatantisocialbehaviorwasassociatedwithalcoholdependence
symptoms in both women and men, even after controlling for SES and family history of substance
dependence (Hartford & Parker, 1994). Therefore, we hypothesized that both ASPD and BPD diagnoses
would be related to greater severity of alcohol and drug dependence among substance-dependent
participants.
WealsohypothesizeddifferencesintheeffectsofASPDandBPDonotherdomainsoffunctioningin
substance-dependentparticipants.Forinstance,ASPDlargelyincludesfeaturesthatinvolveirresponsible,
impulsive, reckless, or criminal behaviors, and as such, would be expected to be associated with legal
difficulties among individuals with SUD. BPD has been associated with depression (Abela, Pain, &
Moussaly,2003;Bellinoetal.,2005;Joyceetal.,2003)andahistoryofchildhoodabuse(Sabo,1997)in
several studies, and one study found that the presence of BPD was associated with greater psychiatric
distress among substance abusers (Morgenstern, Langenbucher, Labouvie, & Miller,1997). In addition,
recent conceptualizations of BPD have emphasized a tendency toward experiential avoidance, or the
avoidance of or escape from unwanted emotions and thoughts (Chapman, Specht, & Cellucci, 2005b;
Hayes, Wilson, Gifford, Follette, & Strosahl, 1996; Linehan, 1993). Therefore, we examined whether
BPD was associated with greater levels of depression and hopelessness, past childhood abuse, and
experiential avoidance among substance-dependent participants.
2. Methods
2.1. Participants
This study received IRB approval prior to data collection. One hundred and seventeen incarcerated
females(M =33.90,S.D.=8.52)fromamultilevelwomen'sprisonvolunteeredtoparticipateinthestudy
age
inresponsetopamphletspostedonthecellblocks.Exclusionarycriteriaincludedacurrentpsychoticepisode
orseriousreadingdifficultiesthatprecludedfillingoutquestionnaires.Twoparticipantswereexcluded,one
because of reading difficulties and the other due to frank mental confusion. Ten participants completed
questionnairesbuthadtransferredtoanotherfacilitybeforecompletingthediagnosticinterviews.Pleasesee
Table 1 for information on the demographic features of the sample. Almost fifty percent (48.6%) of
participantswereincarceratedmostrecentlyfordrug-relatedoffenses,withthemostcommondrug-related
offenseconsistingofdrugpossession(27.6%).Participantsreportedameandurationofcurrentincarceration
of 303.79 days (S.D.=553.58, range=6–2843), suggesting that it was unlikely that participants were
undergoingacutedetoxificationfromalcoholordrugsduringthestudy.
2.2. Procedure
Participantswererecruitedfromtheircell-blocksusingflyersdescribingthestudyasonethatexamines
psychological difficulties characteristic of incarcerated females. Participants were not offered incentives
fortheirresearchparticipation,asthiswasnotallowedunderprisonregulations.Writteninformedconsent
1134 A.L.Chapman, T.Cellucci / AddictiveBehaviors32(2007)1131–1145
wasobtainedfromeachparticipant,andparticipantsweretoldexplicitlythattheirparticipation(orrefusal
toparticipate)wouldnotinfluencetheirtreatmentorstatusinprison.Thestudywasconductedovertwo
separate sessions. During the first session, participants completed a demographics form and a packet of
questionnaires in small groups (4–9 individuals) in a quiet room under supervision.
Duringasecondsession(M=4.74daysafterthefirstsession,S.D.=3.99),participantswereadministered
interviewmeasuresofpersonalitydisordersandsubstancedependence.Theseinterviewslastedapproximately
60–75 min and were conducted individually by doctoral students in clinical psychology or by a licensed
clinicalpsychologist.Allinterviewersweretrainedintheadministrationofpersonalitydisorderinterviewsby
the first author, who had conducted or rated over 100 such interviews. Subsequently, interview ratings for
substancedependenceandpersonalitydisorderswerediscussedduringweeklymeetingstoensurethatthebasis
forratingswasconsistentacrossinterviewers.Questionableresponseswerescoredbasedonteamconsensus.
2.3. Assessment measures
2.3.1. Demographics form
The demographics form included:age, ethnicity, marital status, education, grossyearly income in the
year prior to incarceration (we did not specifically discriminate legal versus illegal income), as well as
questionspertainingtocriminality,includingreasonsforcurrentincarcerationandageatfirstarrest.Age
at first arrest was used as an indicator of the chronicity of participants' legal difficulties in subsequent
MANCOVAs.
2.3.2. Personality disorder assessment
Diagnosticassessmentofborderline(BPD)andantisocialpersonalitydisorder(ASPD)wasconductedvia
theStructuredClinicalInterviewforDSM-IVPersonalityDisorders(SCID-II-INT;First,Gibbon,Spitzer,
Williams, & Benjamin, 1997). The SCID-II has demonstrated good psychometric properties in several
studies(Farmer&Chapman,2002;Firstetal.,1995).First,theSCID-II-PersonalityQuestionnaire(SCID-II-
PQ)wasadministeredasascreeningquestionnaire.Next,theinterviewerconductedtheSCID-IIinterview
andqueriedonlythoseitemsrated“true”ontheSCID-II-PQ.Giventheprevalenceofsubstanceuseamong
femaleprisoners,ratingsweremadebasedoninstanceswhentheinmatewasnotactivelyusingsubstances.
DiagnosesweremadebasedonDSM-IV-TR(APA,2000)cutoffs.
SimilartoChapmanetal.(2005),wecalculatedadimensionalscorerepresentingtheseverityofthePDs
examined in this study. Participants' scores on BPD and ASPD items were coded such that symptoms
Table1
Demographiccharacteristicsofthesample
Maritalstatus % Education % Income % Ethnicity %
Single 32.4 8thgradeorless 10.5 b$5000 36.2 White/Caucasian 71.4
Married 20.0 Somehighschool 13.3 $5000–9999 16.2 NativeAmerican 13.3
Separated/divorced 45.7 GED 27.6 $10,000–14,999 18.1 AfricanAmerican 1.9
Widowed 1.9 Highschoolgraduate 17.1 $15,000–19,999 7.6 Asian/AsianAmerican 1.0
Businessortechnicalschool 6.7 $20,000–24,999 3.8 Latina 9.5
Somecollege 21.0 $25,000–29,999 7.6 Other 2.9
Collegegraduate 3.8 $30,000–49,999 7.6
$50,000+ 2.9
N=105.
A.L. Chapman,T.Cellucci /AddictiveBehaviors 32(2007)1131–1145 1135
deemedclinicallypresent=1,subthreshold=0.50,andabsent=0.IncontrastwithChapmanetal.(2005),in
calculatingthedimensionalscores,weexcludedthosefeaturesofASPDandBPDthatmaypartlydependon
thepresenceofsubstance-relatedbehaviors,inordertoavoidpresentingspuriousassociationsbetweenthese
PDsandsubstancedependence.ForASPD,weexcluded“criminalbehavior”(criterion1;APA,2000).For
example,ifthreeASPDsymptomswereclinicallypresent,twowerepartiallypresent,andonewasabsent,
the resulting dimensional score would be: [3(1.0)+2(0.50)+1(0)]÷6=0.67. For BPD, we excluded
“impulsive,potentiallyself-damagingbehavior”,referredtohereasimpulsivity(criterion4;APA,2000).For
example,iffourBPDsymptomswereclinicallypresent,threepartiallypresent,andoneabsent,theresulting
dimensionalscore would be[4(1.0)+3(0.50)+1(0)]÷8=0.69. In addition,wecalculated ASPDand BPD
diagnosticvariablesthatdidnotincludecriminalbehaviorandimpulsivity,respectively.
2.3.3. Substance dependence assessment
TheTriageAssessmentforAddictiveDisorders(TAAD;Hoffman,2000)isabriefstructuredinterview
of DSM-IV criteria for alcohol and drug abuse and dependence. Participants were asked about their
alcohol and drug use during the 12 months prior to incarceration. In addition to diagnoses, dimensional
scores were calculated that represented the severity of alcohol or drug dependence. Each criterion
positivelyendorsedwasgivenavalueof“1”;eachcriterionnegativelyendorsedwasgivenavalueof“0”.
Thecriteriaforalcoholdependenceordrugdependenceweresummedanddividedbythetotalnumberof
criteria for alcohol or drug dependence (seven criteria each) to yield the dimensional scores.
2.3.4. Childhood abuse
The Childhood Trauma Questionnaire (CTQ; Bernstein et al., 1994) assesses several aspects of
childhoodabuse.Weadministeredabriefversionconsistingofthefiveitemswiththehighestloadingson
eachofthreefactorsfortheCTQ:(1)physicalandemotionalabuse,(2)sexualabuse,and(3)neglect.For
theCTQ,respondentsareaskedtoratefrom1(“nevertrue”)to5(“veryoftentrue”)theextenttowhich
eachitemappliedtotheirexperienceswhilegrowingup.Thecorrelationsamongthesesubscalesforthe
CTQ ranged from .36 to .54. We calculated z-scores for physical and emotional abuse (one scale,
consistingofbothphysicalandemotionalabuse)andforsexualabuseandthensummedanddividedthem
by two to create a childhood abuse composite score (used in subsequent MANCOVA analyses).1
2.3.5. Depressed mood and hopelessness
We measured depressed mood using the Beck Depression Inventory-Second Edition (BDI-II; Beck,
Steer, & Brown, 1996) is a 21-item self-report measure of the severity of depression. BDI-II items
correspond closely with DSM-IV criteria for major depression, and the BDI-II has consistently
demonstrated solid psychometric properties (Beck et al., 1996). The Beck Hopelessness Scale (BHS;
Beck & Steer, 1993) is a 20-item self-report inventory of pessimistic or hopeless attitudes toward the
future. As with the BDI-II, the BHS has demonstrated strong reliability and validity in several studies
(Beck & Steer, 1993). The correlation between the BDI-II and the BHS in the present sample was high,
r=.69. We created a depressed mood composite score (used in subsequent MANCOVA analyses) by
calculating z-scores for depression and hopelessness, summing them, and dividing them by two.
1 Wedid not include the CTQ neglect scale in this composite score, as it demonstrated low internal consistency within the
present sample,α=.43.
1136 A.L.Chapman, T.Cellucci / AddictiveBehaviors32(2007)1131–1145
2.3.6. Experiential avoidance measures
Experiential avoidance tendencies were measured through two different measures: the Acceptance
and Action Questionnaire (AAQ; Hayes et al., 2004), and the White Bear Suppression Inventory
(WBSI; Wegner & Zanakos, 1994). The AAQ (Hayes et al., 2004) measures the general tendency to
avoid unwanted internal experiences, including emotions and thoughts. The AAQ has demonstrated
goodpsychometric properties (i.e., test–retest reliability and internal consistency), and goodconvergent
validity through positive associations with the Dissociative Experiences Scale and the Escape-
Avoidance Scale of the Ways of Coping Questionnaire (WOC; Folkman & Lazarus, 1988) (Hayes
et al., 2004).
The WBSI measures the tendency to avoid or suppress unwanted thoughts The WBSI has
demonstratedgoodinternalconsistency,adequatetoverygoodtest–retestreliability(range:.69–.92),and
goodconcurrentvalidity(WegnerandZanakos,1994).ThecorrelationbetweentheAAQandtheWBSI
was quite high, r=.67. We computed z-scores for both the AAQ and the WBSI and then calculated an
experientialavoidancecompositescore(usedinsubsequentMANCOVAanalyses)bysummingthesez-
scores and dividing them by two.
3. Results
3.1. Preliminary analyses
3.1.1. Data screening and descriptive statistics
Table2displaysthedescriptivestatistics(mean,standarddeviation,andrange)foreachoftheprimary
studyvariables.Amongthesevariables,onlythehopelessnessscoresweresignificantlyskewed.Wedid
not,however,performdatatransformations,becausetheanalysesreportedbelowarerelativelyrobustto
violationsofthenormaldistribution,theskewnessvalueforhopelessnesswasnotexcessivelyhigh(1.68,
S.E.=0.24) (see Ormel & Rijsdijk, 2000 for a discussion of circumstances under which data trans-
formations may be unnecessary), and because we wanted to maintain the interpretability of the coe-
fficients in the analyses reported below.
Table2
Descriptivestatisticsforprimarystudyvariables
Variable M S.D. Range
Drugdependenceseverity 0.64 0.42 0–1.00
Alcoholdependenceseverity 0.47 0.39 0–1.00
BPDseverity 0.49 0.27 0–1.00
BPDseveritywithoutcriterion4 0.46 0.29 0–1.00
ASPDseverity 0.35 0.22 0–0.91
ASPDseveritywithoutcriterion1 0.46 0.24 0–1.00
AcceptanceandActionQuestionnaire(AAQ) 68.76 11.96 39–108
WhiteBearSuppressionInventory(WBSI) 53.45 13.67 15–75
BeckDepressionInventory(BDI-II) 22.23 11.06 4–57
BeckHopelessnessScale(BHS) 4.18 4.73 0–20
ChildhoodPhysicalandEmotionalAbuse(CTQ) 15.37 6.10 5–25
ChildhoodSexualAbuse(CTQ) 14.15 8.08 5–25
Ageatfirstarrest 20.79 8.20 7–44
A.L. Chapman,T.Cellucci /AddictiveBehaviors 32(2007)1131–1145 1137
3.1.2. Prevalence of substance dependence and personality disorders
Fifty-eight(55.2%)ofthe105participantsmetcriteriaforalcoholdependence,73(69.5%)metcriteria
fordrugdependence,and39%metcriteriaforbothalcoholanddrugdependence.Intermsofdiagnosis,
alcohol and drug dependence were not significantly associated, χ2=0.08, ns.
Table 3 shows the proportions of alcohol/drug-dependent vs. non-alcohol/drug-dependent individuals
who met criteria for BPD or ASPD. For these values, we used calculated BPD and ASPD diagnostic
variablesthatsubstanceusemayhaveinfluenced(impulsivityforBPDandcriminalbehaviorforASPD).
The BPD diagnosis demonstrated a trend toward an association with the diagnosis of drug dependence,
χ2=3.25,p=.07,butwasnotsignificantlyassociatedwithalcoholdependence,χ2b0.01,p=.93.Asseenin
Table3,theASPDdiagnosiswassignificantlyassociatedwithbothdrugdependence,χ2=18.98,pb.01and
alcoholdependence,χ2=6.22,p=.01.
3.1.3. Identification of covariates
Weexaminedtheassociationofdemographiccharacteristicswithalcoholanddrugdependenceseverityin
ordertoidentifyanypossibleinfluencesotherthanPDsymptomatologyonthesevariables.Age,numberof
yearsofeducation,income,ethnicity(Caucasianvs.non-Caucasian),andmaritalstatus(marriedvs.single,
separated,ordivorced)werenotsignificantlyassociatedwithalcoholdependenceseverity,andhencewere
not employed as covariates in analyses involving alcohol dependence severity. Number of years of
education, ethnicity, and marital status were not significantly associated with drug dependence severity;
however,age,r=−.25,p=.01,andincome,r=−.27,p=.01,weresignificantlynegativelyassociatedwith
drugdependenceseverity.Ageandincomewereincludedascovariatesinregressionanalysesthatinvolved
drugdependence.
3.2. Association of BPD and ASPD severity with alcohol and drug dependence severity
Asignificantassociationofalcoholanddrugdependencewouldsuggesttheneedtocontrolforalcohol
dependenceindrugdependenceanalysesandviceversainordertoisolatethefactorsspecificallyassociated
witheachtypeofSUD.Thus,weexaminedthecorrelationbetweenalcoholanddrugdependenceseverity,
whichwasnon-significant,r=.04,ns.GiventheorthogonalityoftheseformsofSUDinthepresentstudy,as
planned,weconductedthefollowinganalysesseparatelyforalcoholanddrugdependenceseverity.Interms
ofzero-ordercorrelations,BPDseveritywassignificantlycorrelatedwithASPDseverity,r=.40,pb.01,and
drugdependenceseverity,r=.25,p=.01,butnot with alcoholdependenceseverity,r=.12,p=.22. ASPD
Table3
Proportionsofalcoholanddrug-dependentparticipantswhometcriteriaforASPDandBPD
Variable Alcoholdependence χ2 Drug dependence χ2
Absent(n=47) Present(n=58) Absent(n=32) Present(n=73)
BPD 0.01 3.25a
Absent 76.6% 75.9% 87.5% 71.2%
Present 23.4% 24.1% 12.5% 28.8%
ASPD
⁎⁎ ⁎⁎
Absent 72.3.1% 48.3% 6.21 90.6% 45.2% 18.98
Present 27.7% 51.7% 9.4% 54.8%
apb.10,⁎pb.05,⁎⁎pb.01.
1138 A.L.Chapman, T.Cellucci / AddictiveBehaviors32(2007)1131–1145
severity was significantly correlated with both drug dependence severity, r=.35, pb.01, and alcohol
dependenceseverity,r=.43,pb.01.
We conducted a hierarchical regression analysis to examine whether the association of ASPD and BPD
severity with drug dependence remained significant after controlling for identified covariates and the other
respectivePD.Ageandeducationwereenteredinthefirststep,followedbyASPDseverityandBPDseverity
inthesecondstep.Inthesecondstep,ASPDseveritywassignificant,β=.25,p=.02,butBPDseveritywas
non-significant, β=.11, p=.27. We did not repeat these analyses for alcohol dependence, as neither BPD
severitynoranyofthecovariatesmentionedabovewassignificantlyassociatedwithalcoholdependence.
3.3. Association of BPD and ASPD features with alcohol and drug dependence
We conducted a series of correlational and regression analyses to examine the association of specific
BPD and ASPD features with alcohol dependence and drug dependence severity. As BPD severity was
not significantly correlated with alcohol dependence severity, we did not examine the association of
individual BPD features with alcohol dependence.
3.3.1. BPD features
The following BPD criteria were significantly correlated with drug dependence severity: cognitive
dysregulation,2 r=.31, pb.01, anger dysregulation, r=.25, pb.01, impulsivity, r=.24, pb.01, affect
instability, r=.21, p=.01, and abandonment, r=.18, p=.04. We conducted a hierarchical regression
analysis,withdrugdependenceseverityastheDV.ASPDseveritywasenteredinthefirststep,followed
by the BPD feature of impulsivity in the second step (as mentioned, substance abuse/dependence may
contributeto the rating of this criterion), and the remaining BPD featuresthat had significant zero-order
correlationswithdrugdependenceinthethirdstep.AsseeninTable4,aftercontrollingforASPDinthe
first step, impulsivity no longer was significantly associated with drug dependence severity. In the third
step, none of the other BPD criteria were significant, although cognitive dysregulation demonstrated a
trend (p=.07).
3.3.2. ASPD features
Intermsofzero-ordercorrelations,thefollowingASPDcriteriaweresignificantlyassociatedwithdrug
dependence severity: criminal activity, impulsivity, irresponsibility, and aggressiveness, r's=.47, .35, .34,
and .30, respectively (all p'sb.01). A hierarchical regression analysis was conducted, with BPD severity
entered in the first step, followed by criminal activity in the second step (substance use may directly
contribute to the rating of this criterion), and the three remaining ASPD criteria that were significantly
associated with drug dependence severity in the third step. As seen in Table 4, after controlling for BPD
severityinthefirststep,criminalactivityremainedsignificant,β=.44.Inthethirdstep,onlycriminalactivity
wassignificant,althoughimpulsivitydemonstratedatrend,β=.18,p=.08.
The ASPD features of recklessness, aggressiveness, remorselessness, impulsivity, and conning were
significantlycorrelatedwithalcoholdependenceseverity,r's=.38,.27,.26,.24,and.22,respectively(all
p'sb.02).AsneitherBPDseverity(reportedpreviously)norcriminalactivitywassignificantlycorrelated
with alcohol dependence severity, we did not control for these variables in the subsequent regression
2 “Cognitive dysregulation” refers to BPD criterion 9 (APA, 2000), which involves paranoid thinking and/or dissociative
behaviorinresponse tostress.
A.L. Chapman,T.Cellucci /AddictiveBehaviors 32(2007)1131–1145 1139
Table4
HierarchicalregressionofspecificASPDfeaturesonalcoholanddrugdependenceseverityandBPDfeaturesondrugdependence
severity
Antisocial personality disorder (ASPD) Borderline personalitydisorder (BPD)
Drug dependenceseverity Drug dependence severity
Step Variable β p Step Variable β p
1 BPDseverity .25 b.01 1 ASPDseverity .35 b.01
R2=.06,pb.01 R2=.13,pb.01
2 BPDseverity .12 .21 ASPDseverity .31 b.01
Criminalactivity .44 b.01 Impulsivity .12 .24
ΔR2=.17,pb.01 ΔR2=.01,p=.24
3 BPDseverity .03 .76 23 ASPDseverity .25 .02
Criminalactivity .34 b.01 Impulsivity .07 .52
Impulsivity .18 .08 Affectiveinstability .01 .93
Aggressiveness .07 .49 Angerdysregulation .05 .64
Irresponsibility .10 .30 Cognitivedysregulation .19 .07
ΔR2=.06,p=.05 ΔR2=.04,p=.18
AlcoholDependenceSeverity
1 Conning .13 .19
Impulsivity .03 .76
Aggressiveness .09 .43
Recklessness .33 b.01
Remorselessness .16 .08
ΔR2=.23,pb.01
analyses.Instead,weconductedasimultaneousregressionanalysis,withallfiveoftheASPDcriteriathat
weresignificantlycorrelatedwithalcoholdependenceseverityenteredintothemodel.AsseeninTable4,
only recklessness was significantly and uniquely associated with alcohol dependence severity, β=.33,
although remorselessness demonstrated a trend, β=.16, p=.08.3
3.4. The effects of BPD and ASPD on substance-dependent participants
Two one-way MANCOVAs were performed to examine separately the effects of BPD and ASPD on
substance dependence. In contrast with the regression analyses reported above, for which we conducted
separateanalysesforalcoholanddrugdependence,wecollapsedacrossalcoholanddrugdependencefor
theMANCOVAsandfocusedonwhetheranindividualmetcriteriaforeitheralcoholordrugdependence
(“substancedependence”).ThiswasbecausewehadnoreasontohypothesizethatBPDandASPDwould
differentiallyinfluencethepsychosocialfunctioningofpersonswithalcoholversusdrugdependence.4In
3 Fortheseregressionanalyses,wedecidedagainstcorrectingforcumulativetype-Ierror.Asaspectsoftheseanalyseswere
largelyexploratory,wedidnotbelievethatapplyingconservativecorrectionsfortype-Ierrorwouldhavebeenappropriate.In
addition,Keppel(1991)hasnotrecommendedanyspecialα-levelcorrectionsfora“…reasonablenumberofcomparisons….”
(Keppel, 1991, p. 167). We believe that, within each regression analysis, the number of correlations and/or β-coefficients
reported constitute areasonablenumber of analyses (maximum=9,for BPD), given thepurposesof this study.
4 Nevertheless,weseparatelyexaminedalcoholanddrugdependenceseverityasDVsintheMANCOVAs,ratherthancreatingan
overallcompositeforalcoholanddrugdependenceseverity,giventhatthesevariablesappearedtoberelativelyindependent.
1140 A.L.Chapman, T.Cellucci / AddictiveBehaviors32(2007)1131–1145
Table5
EffectsofBPDandASPDonpsychosocialfunctioninginsubstance-dependentparticipants
BPDandsubstance dependence ASPD andsubstance dependence
Variable M (S.D.) F(1,85) η2 Variable M (S.D.) F(1,85) η2
Ageatfirstarrest 0.49 b.01 Ageatfirstarrest 21.53⁎⁎ .21
Substance-dependent 20.58(8.13) Substance-dependent 23.29(8.12)
BPD+substance- 18.03(6.31) ASPD+substance-dependent 15.91(4.68)
dependent
⁎⁎
Experientialavoidance 11.53 .13 Experientialavoidancecomposite 1.26 .02
composite
Substance-dependent −0.17(0.90) Substance-dependent −0.06(0.98)
BPD+substance- 0.52(0.63) ASPD+substance-dependent 0.21(0.75)
dependent
Abusecomposite 3.23a .04 Abusecomposite 5.33⁎ .06
Substance-dependent −0.10(0.79) Substance-dependent −0.19(0.77)
BPD+substance- 0.29(0.76) ASPD+substance-dependent 0.27(0.76)
dependent
Depression/hopelessness 11.04⁎⁎ .14 Depression/hopelessness 0.40 b.01
Substance-dependent 20.14(9.13) Substance-dependent 19.71(9.63)
BPD+substance- 28.52(12.52) ASPD+substance-dependent 26.63(11.60)
dependent
Drugdependenceseverity 2.27 .03 Drugdependenceseverity 0.89 .01
Substance-dependent 0.67(0.40) Substance-dependent 0.67(0.41)
BPD+substance- 0.84(0.27) ASPD+substance-dependent 0.80(0.31)
dependent
⁎
Alcoholdependenceseverity 4.10 .05
Substance-dependent 0.46(0.36)
ASPD+substance-dependent 0.64(0.38)
apb.10,⁎pb.05,⁎⁎pb.01.
addition, the diagnostic variables representing BPD and ASPD included impulsivity and criminal
behavior,respectively,intheircalculations,incontrastwiththediagnosticvariablesusedtocomputethe
chi-square values reported above (see Section 3.1.2).5
3.4.1. Co-occurrence of BPD
The first MANCOVAexaminedtheeffectsofBPD.The IVconsistedofgroup (substancedependence
without BPD: n=57 vs. BPD+substance dependence: n=31), ASPD severity was the covariate, and the
DVsconsistedof:ageatfirstarrest,childabusecomposite,experientialavoidancecomposite,depression/
hopelessness, and drug dependence severity. We did not include alcohol dependence severity as a DV, as
BPDwasnotsignificantlyassociatedwithalcoholdependenceseverity.TheMANCOVAwassignificant,F
(5,81)=3.55,pb.01,η2=.18.AsseeninTable5,univariateANOVAsindicatedthattheBPD+substance-
5 Dulitetal.(1990)comparedpersonswithsubstanceusedisorderswhometcriteriaforBPDafterexcludingtheimpulsivity
criterion,topersonswithsubstanceusedisorderswhosediagnosisofBPDdependedontheimpulsivitycriterion.Althoughwe
hadalargesampleofindividualswhometsubstancedependencecriteria(n=90),therewereonly12individualsforwhomthe
BPDdiagnosisdependedontheimpulsivitycriterion.Similarly,onlytwoofthesubstance-dependentindividualsrequiredthe
criminal behavior criterion to meet criteria for ASPD. Therefore, we did not follow Dulit et al.'s (1990) approach, as there
wouldnot havebeenenoughparticipants in eachgrouptopermit sufficiently powerful MANCOVAs.