Associations between personality disorders and cannabis use and cannabis use disorder: a population-based twin study

Background and Aims Individual differences in DSM-IV personality disorders (PDs) are associated with increased prevalence of substance use disorders. Our aims were to determine which combination of PDs trait scores best predict cannabis use (CU) and cannabis use disorder (CUD), and to estimate the size and significance of genetic and environmental risks in PD traits shared with CU and CUD. Design Linear mixed-effects models were used to identify PD traits for inclusion in twin analyses to explore the genetic and environmental associations between the traits and cannabis use. Setting Cross-sectional data were obtained from Norwegian adult twins in a face-to-face interview in 1999-2004 as part of a population-based study of mental health. Participants Subjects were 1419 twins (mu(age)=28.2years, range=19-36) from the Norwegian Institute of Public Health Twin Panel with complete PD and cannabis data. Measurements PD traits were assessed using DSM-IV criteria. Life-time CU and CUD were based on DSM-IV abuse and dependence criteria, including withdrawal and craving. Findings After adjusting for age and sex, antisocial [beta=0.23, 95% confidence interval (CI)=0.19-0.28] and borderline PDs (beta=0.20, 95% CI=0.14-0.26) were associated strongly with CU. Antisocial (beta=0.26, 95% CI=0.21-0.31) and borderline PDs (beta=0.12, 95% CI=0.06-0.18) were also linked strongly to CUD. Genetic risks in antisocial and borderline PD traits explained 32-60% of the total variance in CU and CUD. Dependent and avoidant PDs explained 11 and 16% of the total variance in CU and CUD, respectively. Conclusions Individual differences in the liability to cannabis use and cannabis use disorder appear to be linked to genetic risks correlated with antisocial and borderline personality disorder traits.