Psychopathology, treatment utilization and gender in relation to substance abuse

A case-finding investigation was carried out among personnel within various treatment authorities in Stockholm county, with the purpose of identifying and estimating the prevalence of psychopathology among substance abusers known to the treatment providers. A special questionnaire was designed regarding drug and alcohol abuse, current social situation, legal interventions, utilization of treatment resources, and psychological problems. The psychological part of the report form was based on a rating scheme, Rating Ego Balance, developed to operationalize the psychoanalytical concept of personality organization (PO) in terms of critical ego functions. A total of 3,405 persons who had used drugs during the past year were reported to the project, 52% of them came from the social services, 27% from the correctional services, 9% from general psychiatry, and approximately 11 % came from different institutions and intoxication units. The share of men was 73%. Half of the population consisted of heavy substance abusers (with intravenous and/or daily substance abuse). About 60% of the substance abusers were reported to have signs of psychopathology, 50% with borderline level of PO, and 10% with signs of psychotic PO. Different pattems of personality were found which confirm the heterogeniety among substance abusers. At variance with earlier preconceptions, abusing women were not found to harbor more psychological dysfunctions than abusing men. On the contrary, women generally had higher rates of ego balance, especially in reality judgment and neutralization of aggression. However, on the subneurotic levels of PO they had greater relational difficulties and higher rates of depression. Strong associations were found for men between heaviness of abuse and borderline PO as well as between inconsistent pattern of abuse and psychotic PO. No personality pattern or level of psychopathology could be associated to any single drug preferred, which in itself accounted for only 20% of the population. Co-occurrent preference of alcohol potentiates higher levels of psychopathology especially for men. A majority, 70%, had three or less concurrent treatment contacts. A higher number of contacts as well as coordination problems between the treatment providers, were related to lower levels of personality organization. Unclear treatment responsibility assignment was strongly related to psychotic PO for men. Implications for treatment and future research are discussed