The Impact of Stressful Life Events on Alcohol Use Relapse: Findings From the Collaborative Longitudinal Personality Disorders Study

Abstract

Alcohol use relapse is impacted by a variety of environmental, interpersonal, and intrapersonal factors. We examined the interaction between stressful life events, personality disorder subtype, and alcohol use relapse among individuals enrolled in the Collaborative Longitudinal Personality Disorders Study. Negative life events predicted relapse in all participants. In individuals with a history of an alcohol use disorder prior to study entry, positive life events also predicted alcohol use relapse. Individuals with antisocial personality disorder (ASPD) were found to be twice as likely to relapse in response to life stressors compared to individuals with obsessive compulsive personality disorder (OCPD), who were half as likely to relapse in response to life stressors. Further analysis revealed that individuals with OCPD and no history of an alcohol use disorder were almost 10 times more likely to relapse in the face of a stressful romantic problem, while those with ASPD and a history of an alcohol use disorder were six times more likely to relapse in response to a stressful financial event. These findings have implications for both the assessment and the treatment of individuals who present with co-morbid personality and alcohol use disorders.

KEYWORDS:

• Alcohol use disorders
• stress
• personality disorders
• relapse
• dual diagnosis

Editor's Note: While a growing literature exists regarding the implications for treatment and outcome of co-occurring axis I and substance use disorders, relatively little has been written regarding the impact of co-occurring axis II disorders on outcome and treatment efficacy. For most axis I disorders, a category of “secondary to…” substance use exists in the differential diagnosis. For some personality disorders, enduring patterns that may be secondary to substance abuse are among the exclusion criteria, and for others substance use disorders may be a common association. The impact of stressful life events on substance abuse and relapse is somewhat better understood, but still with mixed findings. In the following original article, the authors suggest that some personality subtypes may place patients at higher risk for alcohol use relapse, while others may in fact be protective. Clinical implications suggest a potential “emerging” best practice: that treatment centers begin to routinely screen for personality disorders and that treatment planning considers relapse potential from the perspective of the individual's personality profile.—Robert J. Ronis, MD, MPH

Acknowledgement: This research was supported in part by the following grants from the National Institute on Alcohol Abuse and Alcoholism: K0l AA015137, and the National Institute of Health: MH 50837, 50838, 50840, and 50850.