Using the Temperament and Character Inventory (TCI) to Predict Outcome after Inpatient Detoxification during 100 Days of Outpatient Treatment

Alcohol & Alcoholism Vol. 43, No. 5, pp. 583–588, 2008 Advance Access publication 10 June 2008 doi: 10.1093/alcalc/agn047 TREATMENT Using the Temperament and Character Inventory (TCI) to Predict Outcome after Inpatient Detoxification during 100 Days of Outpatient Treatment Miquel Monras Arnau∗ , Silvia Mondon and Joan Jou Santacreu Alcohol Unit, Clinic Institute of Neuroscience, Hospital Clinic de Barcelona, Barcelona, Spain ∗ Corresponding author: Hospital Clinic de Barcelona, Alcohol Unit, Villarroel 170, 08036 Barcelona, Spain. Tel: +34-932279923; E-mail: (Received 2 October 2007; first review notified 2 February 2008; in revised form 20 April 2008; accepted 23 May 2008; advance access publication 10 June 2008) Abstract — Aims: The aim was to evaluate TCI (Temperament and Character Inventory) scales in identifying personality traits for predicting adherence to outpatient treatments and the relapse of alcohol consumption by alcoholic patients. Methods: Follow-up of 89 alcoholic patients during the 100-day outpatient treatment after their release from the hospital detoxification unit. The detoxification treatment and the follow-up take place in the same hospital unit. Results: Of the patients, 34.8% abandoned the treatment and 31.5% relapsed. The patients who abandoned treatment had lower scores on the Cooperativeness scale. The length of time until the abandonment of the treatment was greater for those with scores >50 for the Self-directedness or Cooperativeness scales. Patients with scores >50 on the Persistence scale were more often abstinent; however, they took the same time to relapse. Conclusions: Higher scores on the TCI personality scales of Persistence, Self-directedness and Cooperativeness predict a better therapeutic evolution, especially with regard to adherence during outpatient treatment after detoxification. INTRODUCTION The relationship between personality and substance addiction has been controversial for many years, but longitudinal studies have ruled out the existence of a specific personality type that predicts future addictions (Vaillant and Milofsky, 1982; Vaillant et al., 1982; Vaillant, 1983a, 1983b). However, it has been found that there are some personality structures with a greater risk of developing substance addiction, antisocial personality disorders (Knop et al., 2003) being the most common. Despite this, the attitude of individuals towards drugs should be understood more as a product and complex interrelation of multiple risk factors, which can also include crises and abuse in childhood (Knop et al., 2003), the high expectancies of alcohol use versus different alternatives (Levy and Earleywine, 2004), the capacity to cope without alcohol (Kjobli et al., 2004) or genetic predisposition (Hesselbrock, 1995), amongst others. At the clinical level, personality disorder risks are being overdiagnosed in alcoholic patients or dependents on other drugs (Dawson et al., 2005), because some of the criteria of personality disorders include substance abuse or may be the result of substance abuse, especially those of B-cluster type, such as antisocial and limit-setting disorders (Rounsaville et al., 1998). Many personality traits or chronic psychiatric symptoms can reflect the way that addictive behaviour shapes the individual since adolescence, confusing the concept of cause and effect. Diagnostic classification systems, such as Axis II of DSMIV, have the problem that many symptoms overlap and are not exclusive among disorders and also, in many cases, are not exhaustive. In the case of personality questionnaires, profile combinations of different scales are used. This system has the advantage of gathering various personality dimensions, placing them in a continuum of severity and presenting them in different measures and combinations within all the potential personality structures (Svrakic et al., 1993, 2002). Although it is obvious that there are profile differences between psychiatric and normal subjects (Svrakic et al., 2002), between alcoholics, depending on when their dependence started (Basiaux et al., 2001), and between the consumers of different drugs (Le Bon et al., 2004), these are not specific. This is because mixing aetiology with the psychological consequences of dependence and the use of global profiles are of little use clinically, as their objective is to support theoretical conceptualizations of dependencies. Given these circumstances, our intention is neither to explore the personality profiles of alcoholic patients or compare them with those of other groups of patients, nor to study the properties of the different classification systems. Our aim is to corroborate the usefulness of the different TCI (Temperament and Character Inventory) scales in identifying simple personality traits that might be useful for predicting adherence to treatment and the risk of relapse in the consumption of alcohol by alcoholic patients undergoing treatment. The hypothesis under study is that the TCI scales, which could be of prognostic use, are those of Persistence (P), reflecting a tendency to persevere despite frustration, and Selfdirectedness (SD), a measure of the ability to control, regulate and adapt one’s behaviour according to chosen goals and values. MATERIALS AND METHODS A cohort of 89 alcoholic patients was recruited from patients admitted consecutively for alcoholic detoxification in a hospital ward of the Alcohol Unit of the Hospital Clinic in Barcelona (UA-HCB) and followed for 100 days after discharge. Criteria for inclusion: alcohol dependence according to DSM-IV criteria. Criteria for exclusion: inability to answer the questionnaire, self-discharge before the end of the detoxification period, alcohol not the main drug that led to admission, re-admission  C The Author 2008. Published by Oxford University Press on behalf of the Medical Council on Alcohol. All rights reserved 584 Monras et al. during the same period as the study or following post-release treatment at another Drug Dependency Centre. Dependence or abuse of other psychoactive substances was not a reason for exclusion so long as the principal dependence was alcohol. We did not exclude patients who presented with personality disorders, other co-morbid psychiatric disorders not associated with chronic alcohol consumption or serious organic diseases. Outcome measures The outcome measures taken of the results are (i) qualitative: abandonment/completion of treatment, abstinence/relapse in alcoholic consumption, and (ii) quantitative: days until the abandonment of treatment (TDA), days until first drink of alcohol (time to first relapse: TFR) and cumulative abstinence duration (CAD), made up of days of abandonment of treatment plus days of alcohol consumption. An alcoholic relapse is regarded as the consumption of any amount of alcohol, excluding minimal alcohol content (alcohol-free) drinks. Dropout from treatment was recorded as one outcome. Procedure Hospital admit (...truncated)