Character disorders occur more often among alcoholics than among the general population. The psychiatric disorders that alcoholics most frequently experience include schizoid disorder, paranoia, depression, manic behavior, masochism, obsessive compulsive disorder, histrionic disorder, disassociative behavior, narcissism and antisocial personality disorder. The evaluation of psychiatric symptoms in alcoholic patients is complicated by the multiple relationships that exist among heavy drinking, psychiatric symptoms, and personality factors. For example, alcoholics with co-occurring depression may be at greater risk of psychosocial problems, relapse, and suicide. Conversely, heavy drinking may produce or worsen symptoms of depression or anxiety. Although clinical experience provides general guidance for treating these patients, further research is needed to develop effective psychosocial and pharmacological therapies aimed at specific combinations of psychiatric and addictive disorders. KEY WORDS: diagnosis; treatment; AODD (alcohol and other drug dependence); behavioral and mental disorder; dual diagnosis; characterity; epidemiology; drug therapy; psychotherapy; literature review
Initial treatment for alcohol dependence consists primarily of detoxification (i.e., treatment of acute physical withdrawal symptoms) and psychosocial strategies aimed at maintaining abstinence. The added presence of a character psychiatric disorder can substantially complicate this approach. For instance, depressive symptoms (e.g., decreased energy and interest) can interfere with a person's attendance at Alcoholics Anonymous (AA) meetings or group psychotherapy sessions, two widely used psychosocial interventions for alcoholism. Similarly, patients with anxiety symptoms (e.g., panic attacks, social phobia) may find it difficult to attend AA meetings or to learn skills for coping with situations that represent a high risk for alcoholic relapse. Alcoholics with ASPD, on the other hand, may show manipulative or aggressive behaviors, which can cause significant interpersonal problems for themselves and for others in treatment.
The diversity of alcoholics with character disorders means that individualized treatment approaches may more effectively address the characterity. However, with the exception of studies of antidepressant therapy for depressed alcoholics, little research exists on how best to treat alcoholics with character psychiatric disorders....
