Personality Disorders and Substance Abuse

Is there a connection between personality disorders and substance abuse?

Thank you Enmanuel Batista from The Recovery Village for suggesting information on Personality Disorders and Addiction. You can find the full article here.

What’s the article’s main focus?

Underlying personality disorders have a direct effect on addiction and recovery. It’s estimated that 10-15% of people in the general public have a personality disorder. This jumps to 35-73% for those being treated for addiction (perhaps higher because not all people struggling with addiction seek treatment). People who struggle with addiction and a personality disorder tend to have more severe substance use concerns.

What’s the connection between personality disorder and substances?

A personality disorder makes navigating life difficult. Personal decisions, self-compassion, motivation, and interpersonal skills can throw someone with a personality disorder into a state of confusion, discomfort, rage, or panic. Substances reduce these uncomfortable feelings so an individual can cope with difficulties, mask feelings, heighten thrill-seeking behaviors, lift depression, or lessen feelings of panic and anxiety. We all want to feel good.

What’s the risk of using substances?

Dependence: Once they wear off, substances tend to make symptoms worse. To reach a ‘comfortable’ feeling, a user needs more of the substance. It creates a downward spiral that the person with the personality disorder doesn’t initially recognize. They become trapped in an addiction.

Poorer therapeutic outcomes: People with personality disorders and addictions tend to have therapist relationship problems, difficulty with motivation to change, and struggle to adhere to medication treatment.

In general, substance use co-occurs most often with antisocial, borderline, avoidant, schizotypal, or paranoid personality disorders. Even legal substances negatively affect personality disorders:

-       Alcohol can

o   Increase impulsivity and suicidality

o   Impair emotional regulation

o   Increase depression and anxiety

o   Interfere in withdrawal and the therapeutic process

o   Make relapse more likely

-       Marijuana can

o   Increase aggression in people with personality disorders

o   Lead to other addictions

o   Frequent high doses are related to psychosis and development of schizotypal personality disorders   

What’s the treatment?

Recovery is possible but for treatment to be effective, personality disorder and substance abuse must be addressed at the same time. Psychotherapy is crucial for people with personality disorders and addictions because:

- The personality disorder often exacerbates the addiction.

- The personality disorder keeps people from therapy.

- The personality disorder deters the medication regimen needed to maintain health.

Cognitive behavior therapy (CBT) is used in the short term to modify thoughts and behaviors to develop coping tools, avoid relapse, and create healthy habits.

Therapies that take place for six months or more:

Dialectical behavior therapy (DBT) teaches clients how to build a life by envisioning, pursuing, and working toward goals for coping with life’s problems.

Dual focused schema therapy (DST) lasts about 24 weeks. Incorporates relapse prevention, addresses the negative beliefs a client has about themselves, and builds positive styles of coping.

Dynamic deconstructive therapy (DDP) effective for people with borderline personality disorder and addiction. This therapy helps clients connect more fully with their personal experiences and develop more authentic relationships. Clients learn to develop relationships while maintaining their own sense of self.

What keeps a person from seeking treatment?

People with a personality disorder usually don’t think they have a problem. They often refuse treatment because they believe other people are the cause of their anger, sadness, irritability, and/or loneliness. Even in therapy, personality disorders are difficult to recognize. They often present as depression/anxiety/substance use. A personality disorder usually isn’t recognized as the primary concern until after therapy starts.

The Recovery Village article lists many more resources. Check them out to learn more about the connection between substance abuse and personality disorders.

 I also found The Connection Between Substance Use Disorders and Mental Illness from the National Institute of Health informative.

 AddictionHelp.com has free, fact-based articles on the different types of addictions and the effect on children, teens, men, and woman in different cultures and identities.

Have an interesting health article that is science based? Contact me! I’m researching houselessness in the Philadelphia area.