Personality Disorders and Substance Abuse

A substance use disorder (SUD) occurs in about 50% of individuals suffering from a personality disorder (PD). In drug use disorders, personality disorders appear to occur more often than in alcohol use disorder (AUD). Personality disorders and substance abuse usually start with mental illness, which can lead to addiction.

Also, the comorbidity with PD positively relates to the severity of the substance use disorder. Hence, personality disorders can lead to substance use disorders. Personality disorders and substance abuse often occur together for many reasons.

What Is a Personality Disorder?

Personality disorders are a group of mental illnesses that involve long-term patterns of thoughts and behaviors that are unhealthy and unbendable. They can cause serious problems at work and with relationships. 

The American Psychiatric Association (APA) states that these disorders and associated traits are stubborn and general in nature. The typical onset of PDs is in adolescence and early adulthood. Over time, the traits stabilize and lead to significant harm to the individual and others. There is no direct cause for PDs. But genes and childhood events may play a role. 

What Are The 10 Personality Disorders?

What Is a Personality DisorderThe Diagnostic and Statistical Manual of Mental Disorders-5th edition (DSM-5) describes a total of 10 PDs. These PDs divide into three clusters:

Cluster A:

  • Paranoid – Paranoid personality disorder (PPD) is a mental condition in which a person has a long-term pattern of suspicion and distrust of others. It’s not a full-blown psychotic disorder like schizophrenia.
  • Schizoid – This disorder is a mental condition in which an individual has a lifelong pattern of indifference to others and social isolation.
  • Schizotypal – This disorder is a mental condition in which a person has disturbances in thought patterns, appearance, behavior, and trouble with relationships.

Cluster B:

  • Antisocial – Antisocial PD is a mental condition in which an individual has a pattern of manipulating, exploiting, and violating the rights of other people with no remorse. This PD could cause problems at work and in relationships. Those with this PD often end up as criminals. 
  • Borderline Borderline PD is a mental condition in which a person has long-term patterns of unstable or chaotic emotions. 
  • Histrionic – This is a mental condition in which people act in an overly emotional and dramatic way to draw attention to themselves.
  • Narcissistic – Narcissistic PD is a mental condition in which a person has an exaggerated sense of self-importance, extreme satisfaction with themselves, and no feelings of empathy for other people.

Cluster B is the one that most studies have related to substance abuse or illegal drugs, mostly cocaine. B is also the group in which there is a greater predominance of impulsivity. This is worth noting because of its role as a vulnerability factor for personality disorders and substance abuse rates.

Cluster C

  • Avoidant – This disorder is a mental condition in which a person has a lifelong pattern of feeling very shy, inadequate, and sensitive to rejection.
  • Dependent – Dependent PD is a mental condition in which people rely on other people too much to meet their emotional and physical needs.
  • Obsessive-compulsive – (OCPD) Obsessive-compulsive personality disorder is a mental condition that includes obsessions  with rules, orderliness, and control.

Studies show higher numbers of cluster C for alcohol consumption. This is another way that personality disorders and substance abuse correlate. 

What is Substance Use Disorder?

Substance use disorder is a complex condition where people use a substance despite harmful consequences. Individuals with SUD have an intense focus on using certain substances such as tobacco, alcohol, or illicit drugs to the point where their ability to function in day-to-day life becomes faulty. These people continue using the substance even though they know it is causing or will cause problems. An extremely severe substance use disorder is an addiction. 

Warning Signs of Substance and Alcohol Use Disorder

Alcohol use disorder and the other types of drug use disorders (opioid, cocaine, cannabis) have the same signs and symptoms that are all included in “substance use disorder.” Symptoms of SUD are:

Behavioral Changes:

  • A drop in attendance and performance at work or school
  • Getting into trouble frequently (fights, accidents, illegal activities)
  • Using substances in physically dangerous situations (while driving or operating a machine)
  • Taking part in secretive or suspicious behaviors
  • Changes in appetite or sleep patterns
  • Changes in personality or attitude
  • Sudden mood swings, irritability, or angry outbursts
  • Spells of hyperactivity, agitation, or dizziness
  • Lack of motivation
  • Seeming to be fearful, anxious, or paranoid without reason

Physical Changes:

  • Bloodshot eyes and abnormally sized pupils
  • Sudden weight loss or gain
  • Decline in physical appearance
  • Unusual smells on the body, breath, or clothes
  • Slurred speech, tremors, loss of coordination

Social Changes:

  • Legal issues linked to substance use
  • Sudden change in friends, hangouts, and hobbies
  • Financial problems or need for money without explanation
  • Using substances even though it’s causing problems in relationships

PDs and SUDs

When a personality disorder and addiction co-occur, PD is usually diagnosed first because people often use alcohol or drugs to try to treat the symptoms of their mental health disorder. Occasionally, the addiction is diagnosed first. After a while, self-medication to treat the symptoms of a personality disorder can lead to addiction. Once an addiction develops, the severity of the PD can also increase.

What’s A Dual Diagnosis?

Dual diagnosis is a term that is used to describe a person who has been diagnosed with a mental health condition and a substance use disorder. About half the people who have serious mental illnesses also have a substance use disorder.

The term “comorbidity” has also been used and it describes two or more disorders occurring in the same person. (Not necessarily a mental disorder and a SUD.) They may occur at the same time or one after the other. Comorbidity also implies interactions between the disorders that can worsen both of them. 

Why Is It Important?

A dual diagnosis is important because both disorders need to be identified and treated at the same time. Otherwise, it’s impossible to treat either disorder successfully. It can be difficult to find treatment for someone who has a mental illness and also a SUD. 

Many programs that treat people with mental disorders don’t know how to treat someone with SUD. Alternatively, programs for substance abusers don’t always treat mental disorders. People with dual diagnoses frequently bounce around from one program to another.

However, more of the psychiatric and drug counseling communities agree that both disorders must be treated at the same time. When a treatment team treats both mental illness and substance abuse, psychotic episodes and suicide attempts decrease. 

Patients with a dual diagnosis don’t fit into most Alcoholic Anonymous or Narcotics Anonymous groups. Individuals who develop positive social networks have a better chance of controlling their illnesses. Peer relationships and healthy recreational activities are extremely important. 

What’s The First Step in Treatment?

PDs and SUDsThe existence of both disorders must be established by a careful evaluation. This might be difficult because the symptoms of one disorder can resemble the symptoms of another. Once an assessment has confirmed the dual diagnosis of substance abuse and a mental illness, professionals, the patient, and family members should work together on a plan for consolidating mental health with SUD treatment as well as motivating the patient.

Treatment for Personality Disorders and SUD

An individual with a dual diagnosis must treat both disorders. It can’t be stressed enough. For treatment to be effective, the patient needs to stop using alcohol or drugs. Treatments may include behavioral therapies and medication. The dual diagnosis treatment interaction may include:

  1. Evaluation of Mental Well-Being 
  2. Detox and Addiction Rehab

Addiction treatment may include a supervised detox period. During detox, the individual will stop using any substances to allow the body to return to normal. During this period of withdrawal, there may be symptoms that are extremely painful and distressing. Supervised detox can help manage and ease the withdrawal symptoms.

The purpose of detox is to prepare the person for rehab. Treatment centers typically offer different levels of care such as:

  • Residential treatment in which the client lives at the treatment facility and is fully supervised 24 hours a day. 
  • Partial hospitalization program is similar to the residential program but the client goes home at night. 
  • Intensive outpatient program in which the patient lives at home but attends counseling and therapy sessions at the facility most days of the week for several hours a day.
  • Outpatient program is the same as the intensive program but without the amount of time commitment required.
  1. Treatment for the Body, Brain, and Soul

Holistic therapy refers to the school of thought that the individual should be treated as a whole person rather than as someone who is sick or has psychological issues. It addresses people in terms of their mind, body, and spirit. Some holistic practices are:

  • Yoga
  • Massage
  • Breathing and relaxation techniques
  • Mindfulness training
  1. Behavioral Therapy

Behavioral therapies are proven to be effective for SUD treatment as well as mental illness. In behavioral therapy, people learn new strategies for adapting their behaviors. Some common behavioral therapies include:

  • Cognitive-behavioral therapy (CBT) – CBT was originally designed to treat depression and is effective in treating many types of SUDs. It teaches people to identify problem behaviors and to develop coping strategies. 
  • Dialectical behavioral therapy (DBT) – DBT is a cognitive-behavioral therapy that concentrates more on managing emotions. It teaches people to live in the moment, cope with stress, handle self-destructive behavior. DBT was originally intended to treat borderline PD but was adapted to treat other mental health conditions.
  1. Relapse prevention training

Aftercare programs offer continued care for people who aren’t quite confident enough to go back to their everyday life. By continuing therapy, living in a sober home, or participating in a 12-step or other self-help program, the possibility of relapse can be greatly reduced. 

Getting Help for Personality Disorders and Substance Abuse

Personality Disorders and Substance AbuseBy now you know that if you have a substance use disorder, there is a good chance you may have a mental disorder too. You might not even be aware of it. This dual diagnosis will only get worse if it’s not treated. And you also know it needs to be treated along with the substance use. 

At The Key to Recovery, we also know this and have programs in place to help you get your life out of the spiral it has become. Whether this is for you or someone close to you, the time to reach out is now. We have a dual diagnosis program and an experienced team who are caring and adept at helping people get to the root of their problems, and moving on to long-lasting recovery. Contact us now.