Cüneyt EVREN, Sera YİĞİTER, MÜGE BOZKURT, Dilara ÇAĞIL, SERAP ÖZÇETİNKAYA ERDOĞAN, FATMA YEŞİM CAN, ELİF MUTLU

Personality dimensions and defense styles that are related with relapse during 12 month follow-up in male alcohol dependents

Amaç: Bu çalışmanın amacı, erkek alkol bağımlılarında yatarak tedaviden sonraki 12 ay içinde alkol kullanımında depreşme ile ilişkili olabilecek savunma mekanizmaları ve kişilik boyutlarını değerlendirmektir. Yöntem: İlk değerlendirme grubu, ardışık olarak servise yatırılmış 70 erkek alkol bağımlısı hastadan oluşmaktaydı. Bu hastalardan 44’ü ile hastanede yatışlarından 1 yıl sonra görüşme yapılabildi. Hastalar yatarak tedavi sırasında Mizaç ve Karakter Envanteri (MKE) ve Savunma Biçimleri Testi (SBT) ile değerlendirildiler. Bulgular: Yatarak tedavi gören 44 alkol bağımlısı hastanın %61.4’ü (n=27) alkol kullanımı depreşmiş olarak değerlendirilmiştir. Alkol kullanımı depreşen gruptakilerin o anki yaşları daha küçüktü. Düzenli alkol kullanımına başlama yaşı, eğitim süresi ve düzenli gelir gruplar arasında farklılık göstermedi. İlk görüşmede saptanan kendi kendini yaralama ve özkıyım öyküsü oranları depreşen grupta daha yüksekti. Yatarak tedaviden sonraki 12 ayda sosyal çevreyi değiştirme oranı depreşen grupta düşükken, alkol dışı madde kullanmış olma ve madde kullanan arkadaşlarıyla görüşmeye devam etme oranları yüksekti. Depreşen grupta “eyleme dökme”, “değersizleştirme” ve “yer değiştirme” ortalama puanları daha yüksekti. Ayrıca aynı savunma mekanizmaları, düşük düzeyde kendi kendini yönetme (KY) ile birlikte depreşmeyi belirleyen değişkenler olmuştur. Analize o anki yaş eklendiğinde ise, alkol bağımlılarında yatarak tedavi sonrası depreşmeyi genç olma ve yüksek eyleme dökme belirlemiştir. Sonuç: Klinisyenler düşük KY ve olgunlaşmamış savunma biçimlerine (özellikle eyleme dökme) sahip genç alkol bağımlıları için dikkatli olmalıdırlar, çünkü bu değişkenler depreşme ile ilişkili görünmektedir.

Erkek alkol bağımlılarında 12 aylık takip süresindeki depreşme ile ilişkili savunma mekanizmaları ve kişilik boyutları

Objective: The aim of this study was to evaluate the defense styles and the personality dimensions that are related with relapse to alcohol use 12 months after inpatient treatment in male alcohol dependents. Methods: Participants were 70 consecutively admitted male alcohol dependents. Among these patients 44 were available to examine after 1 year. Patients were investigated with the Temperament and Character Inventory (TCI) and Defense Styles Q (DSQ) at baseline. Results: Among 44 alcohol dependent inpatients 61.4% (n=27) were considered as relapsed to alcohol use. Current age was lower in relapsed group. Age at regular alcohol use, duration of education, regular income did not differ between groups. Rate of history of self-mutilation and/or suicide attempt at baseline were higher in relapsed group. Rate of changing social environment during 12 months after inpatient treatment was lower in the relapsed group, whereas using drugs and spending time with substance using friends were higher in this group. Mean scores of “acting-out”, “devaluation” and “displacement” were higher in the relapsed group. Also same immature defense styles predicted relapse together with self-directedness (SD). When current age was included in the analysis, being younger and high acting-out predicted relapse in alcohol dependents after inpatient treatment. Conclusions: Clinicians must be careful for younger alcohol dependents with lower SD and for those who use immature defense styles (particularly acting-out) since these variables may be related with relapse.

PDF

___

1. Becker CH. Alcohol dependence, withdrawal, and relapse. Alcohol Res Health 2008; 31:248-261.
2. Miller WR, Walters ST, Bennett ME. How effective is alcoholism treatment in the United States? J Stud Alcohol 2001; 62:211-220.
3. Monahan S, Finney J. Explaining abstinence rates following treatment for alcohol abuse. A quantitative synthesis of patient, research design, and treatment effects. Addiction 1996; 91:787- 805.
4. Dawson DA, Goldstein RB, Grant BF. Rates and correlates of relapse among individuals in remission from DSM-IV alcohol dependence: a 3-year follow-up. Alcohol Clin Exp Res 2007; 31:2036-2045.
5. McLellan AT, Alterman AI, Metzger DS, Grissom GR, Woody GE, Luborsky L, O’Brien CP. Similarity of outcome predictors across opiate, cocaine, and alcohol treatments: role of treatment services. J Consult Clin Psychol 1994; 62:1141-1158.
6. Booth BM, Curran GM, Han X. Predictors of short-term course of drinking in untreated rural and urban at-risk drinkers: effects of gender, illegal drug use and psychiatric comorbidity. J Stud Alcohol 2004; 65:63-73.
7. Bottlender M, Soyka M. Impact of craving on alcohol relapse during and 12 months following, outpatient treatment. Alcohol Alcohol 2004; 39:357-361.
8. Miller WR, Westerberg VS, Harris RJ, Tonigan JS. What predicts relapse? Prospective testing of antecedent models. Addiction 1996; 91:155-171.
9. Yates WR, Booth BM, Reed DA, Brown K, Masterson BJ. Descriptive and predictive validity of a high-risk alcoholism relapse model. J Stud Alcohol 1993; 54:645-651.
10. Brown SA, Vik PW, Patterson TL, Grant I, Schuckit MA. Stress, vulnerability, and alcohol relapse. J Stud Alcohol 1995; 56:538- 545.
11. Connors GJ, Maisto SA, Zywiak WH. Understanding relapse in the broader context of post-treatment functioning. Addiction 1996; 91:173-189.
12. Driessen M, Meier S, Hill A, Wetterling T, Lange W, Junghanns K. The course of anxiety, depression and drinking behaviours after completed detoxification in alcoholics with and without comorbid anxiety and depressive disorders. Alcohol Alcohol 2001; 36:249-255.
13. Strowing AB. Relapse determinants reported by men treated for alcohol addiction: the prominence of depressed mood. J Subst Abuse Treat 2000; 19:469-474.
14. Moss RH, Moss BS. Rates and predictors of relapse after natural and treated remission from alcohol use disorders. Addiction 2006; 101:212-222.
15. Blaya C, Kipper L, Heldt E, Isolan L, Ceitlin LH, Bond M, Manfro GG. Brazilian-Portuguese version of the Defense Style Questionnaire (DSQ-40) for defense mechanisms measure: a preliminary study. Rev Bras Psiquiatr 2004; 26:255-258.
16. Vaillant GE. Ego mechanisms of defense and personality psychopathology. J Abnorm Psychol 1994; 103:44-50.
17. American Psychiatric Association Committee on Nomenclature and Statistics. Diagnostic and Statistical Manual Of Mental Disorders. Fourth ed., Washington DC: American Psychiatric Press; 1994. 18. Cramer P. Defense mechanisms and physiological reactivity to stress. J Pers 2003; 71:221-244.
19. Andrews G, Pollock C, Stewart G. The determination of defense style by questionnaire. Arch Gen Psychiatry 1989; 46:455-460.
20. Hyphantis T. The Greek version of the Defense Style Questionnaire: psychometric properties in three different samples. Compr Psychiatry 2010; 51:618-629.
21. Grebot E, Paty B, Girarddephanix N. Relationships between defense mechanisms and coping strategies, facing exam anxiety performance. Encephale 2006; 32:315-324 (Article in French).
22. Miller WR. Motivation for treatment: a review with special emphasis on alcoholism. Psychol Bull 1985; 98:84-107.
23. Ward LC, Rothaus P. The measurement of denial and rationalization in male alcholics. J Clin Psychol 1991; 47:465-468.
24. Taskent V, Karadag F, Topcuoglu V, Akduman I, Evren C. Psychological defense mechanisms, childhood traumas and dissociative experiences in patients with drug and alcohol dependency. Turk Psikiyatri Derg 22; 2011 (Supp.1):58.
25. Evren C, Cagil D, Ulku M, Ozcetinkaya S, Gokalp P, Cetin T, Yigiter S. Relationship between defense styles, alexithymia and personality in alcohol dependent inpatients. Compr Psychiatry 2012; 53: 860-867.
26. Marlatt GA, Baer JS, Donovat DM, Kivlahan DR. Addictive behaviors: etiology and treatment. Annu Rev Psychol 1988; 39:223-252.
27. Moussas G, Dandouti G, Botsis A, Lykouras L. Coping styles of type I and type II alcohol-dependent men undergoing treatment. Compr Psychiatry 2006; 47:63-68.
28. McCreary DR, Sadava SW. Stres, drinking and the adverse consequences of drinking in two samples of young adults. Psychol Addict Behav 1998; 12:247-261.
29. Waisberg JL. Patient characteristics and outcome of inpatient treatment for alcoholism. Advanc Alcohol Subst Use 1990; 8:9-32.
30. Kose S. A psychobiological model of temperament and character: TCI. New Symposium 2003; 41:86-97.
31. De la Rie SM, Duijsens IJ, Cloninger CR. Temperament, character and personality disorders. J Pers Disord 1998; 12:362-72.
32. Cloninger CR, Svrakic DM. Integrative psychobiological approach to psychiatric assessment and treatment. Psychiatry 1997; 60:120-41.
33. Blaya C, Kipper L, Heldt E, Isolan L, Ceitlin LH, Bond M, et al. Brazilian-Portuguese version of the Defense Style Questionnaire (DSQ-40) for defense mechanisms measure: a preliminary study. Rev Bras Psiquiatr 2004; 26:255-258.
34. Basiaux P, le Bon O, Dramaix M, Massat I, Souery D, Mendlewicz J, Pelc I, Verbanck P. Temperament and Character Inventory (TCI) personality profile and sub-typing in alcoholic patients: a controlled study. Alcohol Alcohol 2001; 36:584-587.
35. Bond M, Paris J, Zweig-Frank H. The Defense Style Questionnaire in borderline personality disorder. J Pers Disord 1994; 8:28-31.
36. Hauser ST, Safyer AW. The Contribution of Ego Psychology to Developmental Psychopathology. In Cicchetti D, Cohen DJ (editors). Developmental Psychopathology. New York: John Wiley, 1995, 555-580.
37. Cannon DS, Keefe CK, Clark LA. Persistence predicts latency to relapse following inpatient treatment for alcohol dependence. Addict Behav 1997; 22:535-543.
38. Müller SE, Weijers HG, Böning J, Wiesbeck GA. Personality traits predict treatment outcome in alcohol-dependent patients. Neuropsychobiology 2008; 57:159-164.
39. First MB, Spitzer RL, Gibbon M, Williams JBW. Structured Clinical Interview For DSM-IV Axis I Disorders (SCID-I), Clinical Version. Washington D.C. and London: American Psychiatric Press, Inc, 1997.
40. Çorapcioglu A, Aydemir O, Yildiz M, Esen A., Koroglu E. DSM- IV Eksen I Bozuklukları (SCID-I) İçin Yapılandırılmış Klinik Görüşme, Klinik Versiyon. Ankara: Hekimler Yayın Birliği, 1999 (Article in Turkish).
41. Kose S, Sayar K, Kalelioglu U, Aydin N, Ak I, Kirpinar I, Aydin N, Kalelioglu U, Kirpinar I, Reeves RA, Przybeck TR, Cloninger CR. Turkish version of the TCI: reliability, validity and factorial structure. Bulletin of Clinical Psychopharmacol 2004; 14:107-131 (Article inTurkish).
42. Cloninger CR, Svrakic DM, Przybeck TR. A psychobiological model of temperament and character. Arch Gen Psychiatry 1993; 50:975-90.
43. Andrews G, Singh M, Bond M. The defence style questionnaire. J Nerv Ment Dis 1993; 18:246-256.
44. Yilmaz N, Gencoz T, Ak M. Psychometric properties of the defense style questionnaire: a reliability and validity study. Turk Psikiyatri Derg 2007; 18: 244-253.
45. Evren C, Durkaya M, Dalbudak E, Celik S, Cetin R, Çakmak D. Factors related with relapse in male alcohol dependents: 12 months follow-up study. Düşünen Adam Journal of Psychiatry and Neurological Science 2010; 23:92-99.
46. Soyka M, Hasemann S, Scharfenberg CD, Löhnert B, Bottlender M. New possibilities in treatment and rehabilitation of alcohol- dependent patients: a catamnestic study on the efficiency of outpatient treatment programmes demonstrated by a model procedure. Nervenarzt 2003; 74:226-234.
47. Pedersen MU, Hesse M. A simple risk scoring system for prediction of relapse after inpatient alcohol treatment. Am J Addict 2009; 18:488-493.
48. Bond M, Perry J. Long-term changes in defense styles with psychodynamic psychotherapy for depressive, anxiety and personality disorders. Am J Psychiatry 2004; 161:1665-1671.
49. Kipper L, Blaya C, Teruchkin B, Heldt E, Isolan L, Mezzomo K, Bond M, Manfro GG. Evaluation of defense mechanisms in adult patients with panic disorder: before and after treatment. J Nerv Ment Dis 2005; 193:619-624.
50. Marchesi C, Parenti P, Aprile S, Cabrino C, De Panfilis C. Defense style in panic disorder before and after pharmacological treatment. Psychiatry Res 2011; 187:382-386.
51. Drapeau M, De Roten Y, Perry JC, Despland J. A study of stability and change in defense mechanisms during a brief psychodynamic investigation. J Nerv Ment Dis 2003; 191:496- 502.
52. Heldt E, Blaya C, Kipper L, Salum GA, Otto MW, Manfro GG. Defense mechanisms after brief cognitive–behavior group therapy for panic disorder. One year follow-up. J Nerv Ment Dis 2007; 195:540-543.
53. Corchs F, Corregiari F, Ferrão YA, Takakura T, Mathis ME, Lopes AC, Miguel EC, Bernik M. Personality traits and treatment outcome in obsessive-compulsive disorder. Rev Bras Psiquiatr 2008; 30:246-50.
54. Fassino S, Pierò A, Tomba E, Abbate-Daga G. Factors associated with dropout from treatment for eating disorders: a comprehensive literature review. BMC Psychiatry 2009; 9:67.
55. Andó B, Must A, Kurgyis E, Szkaliczki A, Drótos G, Rózsa S, Szikszay P, Horváth S, Janka Z, Almos PZ. Personality traits and coping compensate for disadvantageous decision-making in long-term alcohol abstinence. Alcohol Alcohol 2012; 47:18- 24.
56. Sinha R. The role of stress in addiction relapse. Curr Psychiatry Rep 2007; 9:388-395.
57. Larimer ME, Palmer RS, Marlatt GA. Relapse prevention. An overview of Marlatt’s cognitive-behavioral model. Alcohol Res Health 1999; 23:151-160.
58. Evren C, Cinar O, Evren B, Celik S. History of suicide attempt in male substance-dependent inpatients and relationship to borderline personality features, anger, hostility and aggression. Psychiatry Res 2011; 190:126-131.
59. Hingson RW, Heeren T, Winter MR. Age of alcohol-dependence onset: associations with severity of dependence and seeking treatment. Pediatrics 2006; 118:755-763.
60. Lewin JD. Treatment Of Alcoholism And Other Addictions. A Self-Psychology Approach. London: Aronson, 1991.
61. Schauenburg H, Willenborg V, Sammet I, Ehrenthal JC. Self- reported defence mechanisms as an outcome measure in psychotherapy: a study on the German version of the Defence Style Questionnaire DSQ 40. Psychol Psychother 2007; 80:355- 366.
62. Watson DC. Predicting psychiatric symptomatology with the defense style questionnaire-40. Int J Stress Manag 2002; 9:275- 287.
63. Zanarini MC, Weingeroff MA, Frankenburg FR. Defense mechanisms associated with borderline personality disorder. J Pers Disord 2009; 23:113-121.
64. van Wijk-Herbrink M, Andrea H, Verheul R. Cognitive coping and defense styles in patients with personality disorders. J Pers Disord 2011; 25:634-644.
65. Cramer P. Personality, personality disorders, and defense mechanisms. J Pers 1999; 67:535-554.
66. Presniak MD, Olson TR, Macgregor MW. The role of defense mechanisms in borderline and antisocial personalities. J Pers Assess 2010; 92:137-145.
67. Hasin D, Fenton MC, Skodol A, Krueger R, Keyes K, Geier T, Greenstein E, Blanco C, Grant B. Personality disorders and the 3-year course of alcohol, drug, and nicotine use disorders. Arch Gen Psychiatry 2011; 68:1158-1167.
68. Chamorro J, Bernardi S, Potenza MN, Grant JE, Marsh R, Wang S, Blanco C. Impulsivity in the general population: a national study. J Psychiatr Res 2012; 46:994-1001.
69. Svrakic DM, Whitehead C, Przybeck TR, Cloninger CR. Differential diagnosis of personality disorders by the seven- factor model of temperament and character. Arch Gen Psychiatry 1993; 50:991-999.
70. Ornstein P, Cherepon JA. Demographic variables as predictors of alcoholism treatment outcome. J Stud Alcohol 1985; 46:425-432.
71. Jarvis TJ. Implications of gender for alcohol treatment research: a quantitative and qualitative review. Br J Addict 1992; 87:1249- 1261.
72. Zywiak WH, Stout RL, Trefry WB, Glasser I, Connors GJ, Maisto SA, Westerberg VS. Alcohol relapse repetition, gender and predictive validity. J Subst Abuse Treat 2006; 30:349-353.
73. Mundle G, Ackermann K, Günthner A, Munkes J, Mann K. Treatment outcome in alcoholism - a comparison of self-report and the biological markers carbohydrate-deficient transferrin and gamma-glutamyl transferase. Eur Addict Res 1999; 5:91-96.
74. Babor TF, Steinberg K, Anton R, Del Boca F. Talk is cheap: measuring drinking outcomes in clinical trials. J Stud Alcohol 2000; 61:55-63.
75. Hasin D, Liu X, Nunes E, McCloud S, Samet S, Endicott J. Effects of major depression on remission and relapse of substance dependence. Arch Gen Psychiatry 2002; 59:375-380.
76. Willinger U, Lenzinger E, Hornik K, Fischer G, Schönbeck G, Aschauer HN, Meszaros K. European fluvoxamine in alcoholism study group. Anxiety as a predictor of relapse in detoxified alcohol-dependent patients. Anxiety as a predictor of relapse in detoxified alcohol-dependent patients. Alcohol Alcohol 2002; 37:609-612.
77. Grebota E, Coffinet A, Laugier C. Changes during detoxification: depression, hopelessness, defence mechanisms and beliefs. J Ther Comport Cogn 2008; 18:77-83 (Article in French).
78. Parker JD, Taylor GJ, Bagby RM. Alexithymia: relationship with ego defense and coping styles. Compr Psychiatry 1998; 39:91- 98.
79. Marchesi C, Parenti P, Aprile S, Cabrino C, De Panfilis C. Defense style in panic disorder before and after pharmacological treatment. Psychiatry Res 2011; 187:382-386.
80. Vaillant GE. Ego mechanisms of defense. A guide for clinicians and researchers. American Psychiatric Press, 1992.
81. Hruska B, Fallon W, Spoonster E, Sledjeski EM, Delahanty DL. Alcohol use disorder history moderates the relationship between avoidance coping and posttraumatic stress symptoms. Psychol Addict Behav 2011; 25:405-414.