Prevalence of personality disorders among substance abusers in drug rehabilitation centres in Kenya

Abstract

Introduction: Personality disorders playa potential role in vulnerability to substance misuse and dependence. Very little information is available on the co-occurrence of different personality disorders (PDs) and drug use disorders among treatment seeking substance abusers in the Kenyan population. Numerous studies in both population and clinic based settings show a higher prevalence of personality disorders among individuals with substance use disorders than among the general population, with particular prominence of antisocial and border line personality disorder. The high individual and social costs of drug use highlight the need to study factors related to such behaviours. Personality disorder effects can have important clinical implications. Research on the correlates of drug addiction provides insights for understanding aetiology and informs prevention and cessation programs. The present study contributes to this line of research by examining personality disorders associated with substance abuse. Aim: The aim of the study was to establish the prevalence of personality disorders among substance abusers and to identify factors associated with the presence of personality disorders. Study design: A cross-sectional descriptive study. Study site: The study was conducted in the following drug rehabilitation centres in Kenya: Mathari Hospital Rehabilitation Centre, Asumbi Treatment Centres, Red Hill Rehabilitation Centre, Script Resource Centre, Blessed Talbot Rehabilitation centre, Maisha Rehabilitation Centre.' Method: A sample of207 patients admitted in drug rehabilitation centres in Kenya was assessed within a period of three months. Informed consent was sought from the patients. Individual screening for inclusion criteria followed and recruitment was done for patients who met the inclusion criteria. A socio demographic questionnaire was administered to collect socio demographic information on the subjects recruited in the study. SCID II was used to assess for axis II diagnosis of personality disorder. The ASSIST instrument was then administered to assess for the specific substances used in the study population. Descriptive and inferential analysis was done using the Statistical Package for Social Sciences (SPSS) version 12; the results are presented in narratives, tables and charts. alts:Outof207 patients successfully enrolled in the study 115 (5" 7%) of them w~re found to have at least one personality disorder. Of these 16.9% were found to have more than one personality disorder. Majority of the patients with a personality disorder had a Cluster C personalitydisorder (37.7%), followed by Cluster B (19.8%) and lastly Cluster A (12.8%). The mostprevalent personality disorder found in the participants was Avoidant personality disorder(21.3%), followed by Obsessive compulsive pd (14%), Paranoid pd (10%), Antisocial pd(8.7%), Passive Aggressive pd (7.3%),Narcissistic pd (6.3%), Borderline pd (6.3%), Schizotypal pd (1.9%), Dependent pd (1.5%), Schizoid pd (1.5%), Histrionic pd (0.97%), and Depressive.pd (0.48%). Alcohol, tobacco and cannabis were found to be the most abused substances. 95.2% of the participants reported alcohol use, 81.6% reported tobacco use, 55.6% reported cannabis use and 47.8% amphetamine use. Hallucinogens were the least used substance 2.9%. Analysis of the ages of the substance abuser showed the participants with personality disorders were significantly younger than those without personality disorders (p= 0.0059). Substance abusers with personality disorders were less also lesslikely to be married (p=0.04) and employed (p=0.02). No significant association to gender,level of education and religion was found. ClusterB personality disorders occurred more frequently in participants who used cannabis compared to those who did not use cannabis(76% versus 24%, p = 0.003). Similarly this cluster of personality disorders were more common in participant who used amphetamine like substances compared to those who didnot use amphetamine (66% versus 34%, p = 0.014). Conclusion and Recommendation: The prevalence of personality disorders is high among substance abusers admitted in drug rehabilitation centres around Kenya, the most common being avoidant personality disorder followed by obsessive compulsive personality disorder. Accurate identification of patients with personality disorder is valuable for both clinical and research purposes. Further research in community samples is required to clarify the relationship between substance abuse and personality disorder.