People who deal with drug or alcohol abuse and have a personality disorder can still get help and live healthy, productive lives as long as treatment adequately addresses both conditions. Integrated care that treats both issues simultaneously is key to long-term stability.
Personality disorders are not flaws of character or eccentric qualities. These are disorders that prevent you from thinking in healthy and functional ways. Individuals with a personality disorder are not always aware they are dealing with one because they believe their thinking or behavior is normal.
Most personality disorders show up in the teen or young adult years. They can hinder a person’s ability to reach their potential and cause problems forming appropriate relationships.
The National Institute of Mental Health says that up to 9.1 percent of Americans may have one of the personality disorders.
Types of Personality Disorders
The most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) says there are 10 distinct personality disorders. Studies show that people with personality disorder may also meet the criteria for another one.
The DSM-5 also separates personality disorders into three clusters, as follows:
- Cluster A: These personality disorders cause behavior that seems unusual to others. People who have a cluster A personality disorder may exhibit excessive paranoia or suspicions, and they often hold grudges. They may appear eccentric or adhere to unusual beliefs.
Disorders belonging to this cluster are:
- Schizoid personality disorder.
- Schizotypal personality disorder.
- Paranoid personality disorder (PPD).
- Cluster B: These disorders are characterized by symptoms that last for a year, begin in the first years of adulthood, and cannot be caused by traumas or disorders. Symptoms of all or some of these disorders may include antisocial behaviors, difficulties maintaining relationships, and recklessness.
Research shows that family history may contribute to the development of cluster B disorders, which include:
- Narcissistic personality disorder.
- Histrionic personality disorder.
- Borderline personality disorder.
- Antisocial personality disorder.
An estimated 1.4 percent of Americans are affected by borderline personality disorder (BPD). More than any other personality disorder, people with BPD are likely to face co-occurring issues, such as other anxiety disorders, substance use disorders, mood disorders, and impulse control disorders.
- Cluster C: These personality disorders are marked by excess anxiety and dread. They can cause problems in current relationships and difficulties forming new ones.
Cluster C personality disorders include:
- Obsessive-compulsive disorder.
- Dependent personality disorder.
- Avoidant personality disorder.
Getting a Diagnosis
Diagnosing a personality disorder is challenging because a lab, blood, or other conventional test cannot confirm or deny its presence. These tests can still be valuable in ruling out other medical conditions that cause unusual behaviors. As a result, doctors may run these during the assessment phase of care.
Doctors will also take down a patient’s family and medical history. Patients are then referred to a psychiatrist or psychologist if doctors find no physical cause for the behaviors displayed.
A mental health practitioner can then evaluate a patient and use the DSM-5 to assess whether they fit the criteria for any of the personality disorders described above.
How Drugs & Alcohol Are Linked With Personality Disorder
A 2011 study published by Innovations in Clinical Neuroscience found that substance use disorders are common in people with personality disorders. People with BPD are especially at risk of a substance use disorder.
The study says the link between BPD and substance misuse is strong, and patients are most likely to abuse prescription medication. The study also found that:
- People with more than one psychiatric disorder are more likely to misuse substances than people with one confirmed disorder.
- Not all personality disorders present the same potential to misuse substances.
- Men and women with BPD present the same probability of abusing alcohol and recreational substances.
- People who abuse alcohol are 35 times more likely to be diagnosed than BPD than people who don’t drink excessively.
Why Is Substance Abuse More Likely?
As explained by the National Institute on Drug Abuse (NIDA), drug addiction is a mental illness because it changes the way a person’s brain works, shifting their priorities, decreasing their ability to control impulses, and developing a new hierarchy of needs.
A person who deals with substance misuse and a mental health or other chronic condition is said to have a co-occurring disorder or dual diagnosis.
Data shows that mental health issues and substance abuse are linked in the following ways:
- Genes can cause a person to be more susceptible to both drug abuse and mental health issues.
- Environmental factors can worsen a person’s genetic proclivities.
- Having a mental health condition may cause a person to turn to drugs for self-medication and enhance a drug’s ability to make that person feel pleasure.
Treating a co-occurring personality disorder can be a challenge because habitual drug use can also trigger mental health conditions, making it hard to pin down the cause of a mental illness. In addition, prescription medication can cause behavioral changes that resemble those of a personality disorder.
Treating Co-Occurring Disorders
The good news is that people with co-occurring disorders can find help and lead productive lives, regardless of the root cause of the disorder.
You are not alone if you deal with co-occurring disorders. The National Alliance on Mental Illness (NAMI) says that up to 9.2. million adults dealt with co-occurring substance use disorders and mental illnesses in 2018.
Per the National Institute on Drug Abuse (NIDA), effective treatments for substance use disorders:
- Deal with all aspects of a patient’s needs, not just addiction.
- Focus on any possible mental illnesses.
- Tailor treatment approaches to individual situations.
- Persist as long as necessary to ensure recovery.
- Are modified as the person progresses in recovery.
Common methods used in treatment programs for co-occurring disorders include:
- Therapy. The American Journal of Psychiatry supports the use of behavioral therapy to help those dealing with substance use disorders. This kind of therapy can also be valuable in addressing personality disorders. Types of therapy include:
- Contingency management. Individuals get rewards for meeting goals. This therapy has shown to be effective in helping those with substance use disorders.
- Motivational interviewing. This type of therapy is meant to help people make better choices and address the things that keep the unmotivated or unable to meet goals.
- Cognitive behavioral therapies and skills training. These can help people understand the underlying effects and consequences of drug use. They also teach the skills necessary to stay sober, such as avoiding triggers and social situations that make substance use a temptation.
- Medication. Social Work in Public Health states that medications can be used to treat people with substance use disorders. They can manage symptoms of withdrawal, reduce or stop cravings, and prevent relapse as a part of medication-assisted treatment (MAT).
Common medications include those designed to address:
- Smoking cessation tools include Chantix, bupropion, or gums, patches, and lozenges. These tools can reduce cravings for smoking and lessen withdrawal symptoms.
- Alcohol use disorder. Benzodiazepines, which should only be used in the short term, can reduce stress caused by withdrawal from alcohol. Disulfiram (Antabuse), naltrexone, and Campral can decrease likelihood of relapse and mitigate cravings. In cases of severe alcohol addiction, medications are necessary to prevent life-threatening seizures during withdrawal.
- Opioid use disorder. Methadone and buprenorphine are commonly used in MAT. They can decrease cravings, manage symptoms of withdrawal, and greatly reduce the likelihood of relapse during opioid detox.
- Evaluation for co-occurring disorders. The Substance Abuse and Mental Health Services Administration (SAMHSA) says that everyone who receives MAT must receive counseling. Everyone who goes into treatment facilities or starts a recovery program undergoes a preliminary evaluation for all kinds of health issues. Physical and mental health are assessed, and treatment is expected to be modified as changes are deemed necessary.
This ensures that people with co-occurring disorders receive proper treatment. If a co-occurring mental health issue is not addressed during substance abuse treatment, relapse is highly likely.
- Support groups. Substance Abuse and Rehabilitation explains that peer support groups have a great track record of helping people in recovery as well as their loved ones. These groups are not the same as group therapy. Support groups are led by nonprofessionals. They are a great way to form a community and share experiences with people who have the same struggles.
Well-known support groups include:
- 12-step groups, such as Alcoholics Anonymous and Narcotics Anonymous. These are perhaps the best-known support groups for those struggling with substance abuse. They provide a structure of accountability and support for those in recovery. Meetings can be found all over the world. AA, NA, and associated groups do have a religious association that some people don’t like.
- SMART Recovery. Studies show that alternatives to groups like AA can be just as effective as their more spiritual counterparts. Self-Management and Recovery Training (SMART) can provide support for people with substance abuse, eating disorders, and gambling addiction. They use a four-point program to help people gain control of their issues.
- Women for Sobriety. WFS focuses on abstinence and sharing experiences with women who have faced substance abuse and other issues and building an understanding of how physical and mental deprivations can lead to substance abuse, aiming to teach members to become confident in their daily lives. Learn more about WFS at womenforsobriety.org.
A Path Forward in Recovery
Integrated treatment is the key to sustained recovery from personality disorders and substance abuse. Choose a treatment facility that offers a holistic approach to recovery, treating patients on all fronts.
If only one issue is treated, it’s highly likely that symptoms of the other disorder will lead to relapse of the treated issue. When it comes to co-occurring disorders, you can’t achieve recovery unless you address the whole person.
Treatment won’t separate each disorder. Instead, both disorders will be simultaneously addressed in therapy sessions. As a result, patients see progress in all areas of life, and this leads to lasting recovery.