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.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 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

  • Psychometrica (2015).

  • 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

Journal information
Impact Factor

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 116 39 0
PDF Downloads 49 24 3