Psychiatric comorbidity and the persistence of drug use disorders in the United States

Aims DSM-IV drug use disorders, a major public health problem, are highly comorbid with other psychiatric disorders, but little is known about the role of this comorbidity when studied prospectively in the general population. Our aims were to determine the role of comorbid psychopathology in the 3-year persistence of drug use disorders. Design and setting Secondary data analysis using waves 1 (2001-02) and 2 (2005-05) of the National Epidemiologic Survey on Alcohol and Related Conditions. Participants Respondents with current DSM-IV drug use disorder at wave 1 who participated in wave 2 (n=613). Measurements Alcohol Use Disorders and Associated Disabilities Interview Schedule IV (AUDADIS-IV) obtained DSM-IV Axis I and II diagnoses. Persistent drug use disorder was defined as meeting full criteria for any drug use disorder between waves 1 and 2. Findings Drug use disorders persisted in 30.9% of respondents. No Axis I disorders predicted persistence. Antisocial [odds ratio (OR)=2.75; 95% confidence interval (CI): 1.27-5.99], borderline (OR=1.91; 95% CI: 1.06-3.45) and schizotypal (OR=2.77; 95% CI: 1.42-5.39) personality disorders were significant predictors of persistent drug use disorders, controlling for demographics, psychiatric comorbidity, family history, treatment and number of drug use disorders. Deceitfulness and lack of remorse were the strongest antisocial criteria predictors of drug use disorder persistence, identity disturbance and self-damaging impulsivity were the strongest borderline criteria predictors, and ideas of reference and social anxiety were the strongest schizotypal criteria predictors. Conclusions Antisocial, borderline and schizotypal personality disorders are specific predictors of drug use disorder persistence over a 3-year period.