Franques P, Auriacombe M, Tignol J
Laboratoire de Psychiatrie, Université Victor-Ségalen Bordeaux 2, France.
Encephale. 2000 Jan-Feb;26(1):68-78.
Within the field of substance abuse, it is now widely admitted that the addictive personality does not exist. No one personality type is predisposed to addiction. The predisposition to drug dependence involves many different factors: psychological, social, familial, biological. None of these factors can be the sole determinant of drug dependence. Keeping that in mind, it is of interest to review the recent data on the relationship between personality traits or disorders and opiate and cocaine dependence. Using DSM and ICD categorical assessment, no single personality disorder emerged, instead a range of personality disorders has been evaluated in opiate and cocaine dependent subjects. Every type of personality disorders (PD) existed but cluster BPD were the most common (especially antisocial personality disorder in opiate addicts). However, it is noteworthy that a large minority to a majority of subjects did not display any king of PD. The implication of these results is that antisocial PD is probably over-diagnosed in drug dependence clinical settings. The studies reviewed failed to demonstrate that personality disorders were strong predictors of outcome in opiate or cocaine dependence. However, opiate dependent PD subjects entering treatment had more severe problems and lower retention rate than non PD subjects. But the amount of improvement was not significantly different between PD subjects and non PD subjects. This demonstrated that substance dependent PD patients could benefit from treatment whose intensity and duration must be adjusted. There is good support for the idea that Sensation Seeking trait is a vulnerability factor to substance abuse. But after dependence develops, sensation seeking is probably irrelevant to continued use of the drugs. This break between the psychopathology of vulnerability of substance abuse and the psychopathology of dependence raises the question of the existence of dramatically different factors involved in both phases of addiction.
在药物滥用领域，现在人们普遍承认成瘾人格并不存在。没有哪一种人格类型更容易成瘾。药物依赖的易感性涉及许多不同因素：心理、社会、家庭、生物因素。这些因素中没有一个能成为药物依赖的唯一决定因素。牢记这一点，回顾一下近期关于人格特质或障碍与阿片类药物及可卡因依赖之间关系的数据是很有意义的。使用《精神疾病诊断与统计手册》（DSM）和《国际疾病分类》（ICD）的分类评估方法，并未出现单一的人格障碍，相反，在阿片类药物和可卡因依赖者中评估了一系列人格障碍。每种人格障碍（PD）都存在，但B类人格障碍最为常见（尤其是阿片类成瘾者中的反社会人格障碍）。然而，值得注意的是，相当一部分到大多数受试者并未表现出任何类型的人格障碍。这些结果意味着在药物依赖临床环境中，反社会人格障碍可能被过度诊断。所回顾的研究未能证明人格障碍是阿片类药物或可卡因依赖预后的有力预测指标。然而，进入治疗的阿片类药物依赖人格障碍受试者比非人格障碍受试者存在更严重的问题且留存率更低。但人格障碍受试者与非人格障碍受试者之间的改善程度并无显著差异。这表明药物依赖人格障碍患者可以从治疗中获益，治疗强度和持续时间必须进行调整。有充分的证据支持这样一种观点，即寻求刺激特质是药物滥用的一个易感性因素。但在成瘾形成后，寻求刺激可能与持续使用药物无关。药物滥用易感性的精神病理学与成瘾的精神病理学之间的这种脱节，引发了成瘾两个阶段涉及截然不同因素的问题。
