Axis I and Axis II disorders in alcoholics and drug addicts: Fact or artifact?

Objective: It has been argued that Axis I and Axis II disorders diagnosed i n substance users refer to substance-induced conditions rather than to inde pendent psychiatric conditions; this argument will be referred to as the su bstance-related artifact hypothesis. Furthermore, Axis II symptoms co-occur ring with Axis I disorders have been attributed to the contamination of per sonality assessment by mood and/or anxiety state effects (the trait-state a rtifact hypothesis). The present study is the first to prospectively examin e thr validity of these two hypothesized "artifacts" in substance users. Me thod: In 276 individuals (57.6% female) applying for substance use treatmen t, current substance use disorders, mood/anxiety disorders and Axis II diso rders were diagnosed using semistructured interviews both at baseline and a t I-year follow-up. The substance-related artifact hypothesis is tested by examining the covariation between recovery from substance use disorders on the one hand and recovery from and/or improvement of mood/anxiety and Axis II disorders on the other hand. The trait-state artifact hypothesis is test ed by examining the covariation between recovery from mood/anxiety disorder s on the one hand and recovery from and/or improvement of Axis II disorders on the other hand. Results: Recovery from substance use disorders covaried with recovery from and improvement of mood/anxiety disorders, bur not with recovery from or improvement of Axis II pathology. Furthermore, recovery f rom mood/anxiety disorders covaried with recovery from and improvement of p ersonality disorders, in particular Cluster C disorders. Conclusions: Resul ts from this study suggest-that mood/anxiety disorders, but not personality disorders, diagnosed among people with substance use disorder may partly r eflect substance-related artifacts. Furthermore, this study provides eviden ce for the contention that semistructured interview assessment of Axis LI, at least without inquiry on an item-by-item basis, is susceptible to contam ination by mood/anxiety slate effects.