PERSONALITY-DISORDERS PREDICT RELAPSE IN ALCOHOLIC PATIENTS

This prospective study examines the association of DSM-III-R Axis II c omorbidity with (time to) relapse since the end of treatment in a samp le of 105 outpatient and 82 inpatient alcoholics. Furthermore. this st udy addresses the role of motivation for change, time in program, and working alliance in the mechanism underlying the association between A xis II and relapse. We found that Axis II comorbidity in alcoholics is a robust predictor of relapse following treatment, while the effect i s strongest in outpatients with low motivation for change and/or short time in program. Motivation for change and time in program did not me diate the association of Axis II with relapse. We also found poor work ing alliance to be related to personality pathology among inpatients, and from our findings it can be hypothesised that poor working allianc e is part of the mechanism underlying the observed impact of Axis II o n treatment outcome in outpatients. A preliminary model of the role of personality pathology in the mechanism of relapse is proposed. (C) 19 98 Elsevier Science Ltd.