Assessment of Personality Problems among Patients with Substance Use Disorders

Open access


AIM – Several studies have shown that personality disorders (PDs) are frequently occurring among patients with substance use disorders (SUDs). A development from research of co-occurrence estimates in this patient group investigates personality problems as dimensional constructs, which seek to capture the core of personality pathology. The aim of our study was to explore whether personality problems might be assessed among SUD patients in early stages of treatment. We also sought to investigate personality problem severity among Norwegian adult SUD patients.

DESIGN – Personality problems were assessed using the self-report questionnaire Severity Indices of Personality Problems (SIPP-118). The study sample consisted of 155 SUD patients currently in treatment at detoxification sections at Oslo University Hospital.

RESULTS – Though psychometric evaluation of the SIPP-118, we found that personality problems could be assessed with high levels of internal consistency and convergent validity in SUD patients during detoxification. This is an important contribution to the discussion concerning time and context of personality pathology assessment in the SUD treatment field. The results indicated that SUD patients have personality problems at a level of severity comparable to previously investigated PD patient samples, and significantly more severe than personality problems found in normal population samples. This indicates that personality problems are a common, as well as a detrimental, feature among SUD patients, which further points towards considering these in all aspects of SUD treatment.

CONCLUSIONS – Assessing personality problems early in treatment may enable a more integrated approach to SUD treatment targeting personality problems and substance-related problems.

Allport, G. W. (1937). Personality: A psychological interpretation. Oxford, England: Holt.

American Psychiatric Association (2006). Practice guideline for the treatment of patients with substance use disorders. Retrieved from

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Andrea, H., Verheul, R., Berghout, C., Dolan, C., van der Kroft, P., Bateman, A. W., . . . Busschbach, J. J. V. (2007). Measuring the core components of maladaptive personality: Severity Indices of Personality Problems (SIPP-118) (No. Report 005). Medical Psychology and Psychotherapy: Reports. Retrieved from

Arnevik, E., Wilberg, T., Monsen, J. T., Andrea, H., & Karterud, S. (2009). A cross-national validity study of the Severity Indices of Personality Problems (SIPP-118). Personality and Mental Health, 3(1), 41–55. doi:10.1002/Pmh.60

Bastiaansen, L., De Fruyt, F., Rossi, G., Schotte, C., & Hofmans, J. (2013). Personality disorder dysfunction versus traits: Structural and conceptual issues. Personality Disorders: Theory, Research, and Treatment, 4(4). doi:10.1037/per000001823834515

Berghuis, H., Kamphuis, J. H., & Verheul, R. (2014). Specific personality traits and general personality dysfunction as predictors of the presence and severity of personality disorders in a clinical sample. J Pers Assess, 96(4), 410–416. doi:10.1080/00223891.2013.834825

Berghuis, H., Kamphuis, J. H., Verheul, R., Larstone, R., & Livesley, J. (2013). The General Assessment of Personality Disorder (GAPD) as an instrument for assessing the core features of personality disorders. Clinical Psychology & Psychotherapy, 20(6), 544–557. doi:Doi 10.1002/Cpp.1811

Brorson, H. H., Arnevik, E. A., Rand-Hendriksen, K., & Duckert, F. (2013). Dropout from addiction treatment: A systematic review of risk factors. Clinical Psychology Review, 33(8), 1010–1024. doi:10.1016/j.cpr.2013.07.007

Campbell, A. N. C., Nunes, E. V., McClure, E. A., Hu, M. C., Turrigiano, E., Goldman, B., & Stabile, P. Q. (2013). Characteristics of an outpatient treatment sample by primary substance of abuse. Journal of Addiction Medicine, 7(5), 363–371. doi:10.1097/ADM.0b013e31829e3971

Carver, C. S., & Miller, C. J. (2006). Relations of serotonin function to personality: Current views and a key methodological issue. Psychiatry Research, 144(1), 1–15. doi:10.1016/j.psychres.2006.03.013

Cohen, J. (1992). Statistical power analysis. Current Directions in Psychological Science, 1(3), 98–101.

Conway, K. P., Kane, R. J., Ball, S. A., Poling, J. C., & Rounsaville, B. J. (2003). Personality, substance of choice, and polysubstance involvement among substance dependent patients. Drug and Alcohol Dependence, 71, 65–75. doi:10.1016/S0376-8716(03)00068-1

Del Boca, F. K., & Noll, J. A. (2000). Truth or consequences: The validity of self-report data in health services research on addictions. Addiction, 95, S347–S360. doi:10.1080/09652140020004278

DeVon, H. A., Block, M. E., Moyle-Wright, P., Ernst, D. M., Hayden, S. J., Lazzara, D. J., . . . Kostas-Polston, E. (2007). A psychometric toolbox for testing validity and reliability. J Nurs Scholarsh, 39(2), 155–164. doi:10.1111/j.1547-5069.2007.00161.x

Feenstra, D. J., Hutsebaut, J., Verheul, R., & Busschbach, J. J. V. (2011). Severity Indices of Personality Problems (SIPP-118) in adolescents: Reliability and validity. Psychological Assessment, 23(3), 646–655. doi:10.1037/a0022995

Field, A. E. (2009). Discovering statistics using IBM SPSS Statistics (3rd ed.). London: Sage Publications.

Flores, P. J. (2001). Addiction as an attachment disorder: Implications for group therapy. International Journal of Group Psychotherapy, 51(1), 63–81. doi:10.1521/ijgp.

Flynn, P. M., & Brown, B. S. (2008). Cooccurring disorders in substance abuse treatment: Issues and prospects. Journal of Substance Abuse Treatment, 34(1), 36–47. doi:10.1016/j.jsat.2006.11.013

Folkehelseinstituttet (2014). Folkehelserapporten 2014: Helsetilstanden i Norge. Retrieved from

Fridell, M., & Hesse, M. (2006). Psychiatric severity and mortality in substance abusers: A 15-year follow-up of drug users. Addictive Behaviors, 31(4), 559–565. doi:10.1016/j.addbeh.2005.05.036

Grant, B. F., Stinson, F. S., Dawson, D. A., Chou, S. P., Ruan, W. J., & Pickering, R. P. (2004). 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. Archives of General Psychiatry, 61(4). doi:10.1001/archpsyc.61.4.36115066894

Helsedirektoratet. (2012a). Nasjonal faglig retningslinje for utredning, behandling og oppfølging av personer med samtidig ruslidelse og psykisk lidelse – ROP-lidelser. Retrieved from

Helsedirektoratet. (2012b). Prioriteringsveileder – Tverrfaglig spesialisert rusbehandling (TSB). Retrieved from

Hughes, K. (2007). Migrating identities: The relational constitution of drug use and addiction. Sociology of Health & Illness, 29(5), 673–691. doi:10.1111/j.1467-9566.2007.01018.x

Interactive Statistics (2015).

Karterud, S., Wilberg, T., & Urnes, Ø. (2010). Personlighetspsykiatri. Oslo: Gyldendal akademisk.

Kofoed, L., Kania, J., Walsh, T., & Atkinson, R. M. (1986). Outpatient treatment of patients with substance-abuse and coexisting psychiatric disorders. American Journal of Psychiatry, 143(7), 867–872.

Kokkevi, A., Hartgers, C., Blanken, P., Hendriks, V., Pozzi, G., Tempesta, E., . . . Uchtenhagen, A. (1994). European Addiction Severity Index, a guide to training and administering EuropASI interviews. Retrieved from

Livesley, W. J., & Jang, K. L. (2000). Toward an empirically based classification of personality disorder. Journal of Personality Disorders, 14(2), 137–151. doi:10.1521/pedi.2000.14.2.137

Livesley, W. J., & Jang, K. L. (2005). Differentiating normal, abnormal, and disordered personality. European Journal of Personality, 19(4). doi:10.1002/per.559

Marlowe, D. B., Husband, S. D., Bonieskie, L. M., Kirby, K. C., & Platt, J. J. (1997). Structured interview versus self-report test vantages for the assessment of personality pathology in cocaine dependence. Journal of Personality Disorders, 11(2), 177–190.

Maslin, J., Graham, H. L., Cawley, M., Copello, A., Birchwood, M., Georgiou, G., . . . Orford, J. (2001). Combined severe mental health and substance use problems: What are the training and support needs of staff working with this client group? Journal of Mental Health, 10(2), 131–140. doi:10.1080/09638230020023697

Morisano, D., Babor, T. F., & Robaina, K. A. (2014). Co-occurrence of substance use disorders with other psychiatric disorders: Implications for treatment services. Nordic Studies on Alcohol and Drugs, 31(1), 5–25. doi:10.2478/nsad-2014-0002

Ravndal, E., Vaglum, P., & Lauritzen, G. (2005). Completion of long-term inpatient treatment of drug abusers: A prospective study from 13 different units. European Addiction Research, 11(4), 180–185. doi:10.1159/000086399

Rounsaville, B. J., Gawin, F., & Kleber, H. (1985). Interpersonal psychotherapy adapted for ambulatory cocaine abusers. American Journal of Drug and Alcohol Abuse, 11(3–4), 171–191. doi:10.3109/00952998509016860

Sher, K. J., & Trull, T. J. (2002). Substance use disorder and personality disorder. Current Psychiatry Reports, 4(1), 25–29.

Skodol, A. E., Oldham, J. M., & Gallaher, P. E. (1999). Axis II comorbidity of substance use disorders among patients referred for treatment of personality disorders. American Journal of Psychiatry, 156(5), 733–738.

Stewart, J., Dewit, H., & Eikelboom, R. (1984). Role of unconditioned and conditioned drug effects in the self-administration of opiates and stimulants. Psychological Review, 91(2), 251–268. doi:10.1037/0033-295x.91.2.251

Thorberg, F. A., & Lyvers, M. (2006). Attachment, fear of intimacy and differentiation of self among clients in substance disorder treatment facilities. Addictive Behaviors, 31(4), 732–737. doi:10.1016/j.addbeh.2005.05.050

Trenz, R. C., Scherer, M., Harrell, P., Zur, J., Sinha, A., & Latimer, W. (2012). Early onset of drug and polysubstance use as predictors of injection drug use among adult drug users. Addictive Behaviors, 37(4), 367–372. doi:10.1016/j.addbeh.2011.11.011

Trull, T. J., Sher, K. J., Minks-Brown, C., Durbin, J., & Burr, R. (2000). Borderline personality disorder and substance use disorders: A review and integration. Clinical Psychology Review, 20(2), 235–253. doi:10.1016/S0272-7358(99)00028-8

van Kampen, D. (2002). The DAPP-BQ in The Netherlands: Factor structure and relationship with basic personality dimensions. Journal of Personality Disorders, 16(3), 235–254.

Verheul, R. (2001). Co-morbidity of personality disorders in individuals with substance use disorders. European Psychiatry, 16(5). doi:10.1016/S0924-9338%2801%2900578-811514129

Verheul, R., Andrea, H., Berghout, C. C., Dolan, C., Busschbach, J. J. V., van der Kroft, P. J. A., . . . Fonagy, P. (2008). Severity Indices of Personality Problems (SIPP-118): Development, factor structure, reliability, and validity. Psychological Assessment, 20(1), 23–34. doi:10.1037/1040-3590.20.1.23

Nordic Studies on Alcohol and Drugs

The Journal of Nordic Centre for Welfare and Social Issues

Journal Information

IMPACT FACTOR 2017: 0.683
5-year IMPACT FACTOR: 0.752

CiteScore 2018: 0.64

SCImago Journal Rank (SJR) 2018: 0.313
Source Normalized Impact per Paper (SNIP) 2018: 0.456


All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 108 69 1
PDF Downloads 39 29 1