Personality Disorder and Substance Use Disorder Outside Treatment Settings: The Prison Community

Background: Studies on comorbidity of personality disorder (PD) and substance use disorders (SUDs) have largely been done on normal and unrestricted environments and on free and unrestricted patients. Illicit drugs are used in prisons despite their highly structured controlled environment. The few studies on the health of prison inmates have indicated high levels of mental disorder, yet no studies have been done on comorbidity of SUDs and PD in the prison community.

Objectives: To determine the prevalence of SUDs and PD in the prison community and the degree of comorbidity between both disorders in this community.

Methods: Prison inmates who met the inclusion criteria were interviewed using (IPDE) International Personality Disorder Examination and Sections 10 and 11of the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Both instruments are semi structured questionnaires modified to conform to DSM-111-R (Diagnostic and Statistical Manual) and ICD-10 (International Classification of Diseases) classifications. ICD-10 classification was used for the diagnoses. The data was fed into the Statistical Package for Social Sciences (SPSS/PC+) and cross- tabulation of the variables obtained using chi-square and t- test.

Results: The study showed that out of the 213 inmates that consented to the study, (77) 36% had SUDs, and (111) 52% had PD with Borderline/ Impulsive PD Dissocial PD and Anankastic PD having the highest prevalence of comorbidity.

Conclusion: The prison communities harbour inmates with SUD and PD. A strong association has been established between both disorders with a comorbid prevalence rate of 70%. An urgent need for a close medical and psychiatric care is advocated.