The co-occurrence of personality disorders (PD) and substance use disorders (SUD) is very prevalent, with some reports suggesting that between 34 and 73 percent of individuals diagnosed with substance use disorders also meet the criteria for a personality disorder.
This comorbidity is associated with increased severity of symptoms, poorer treatment outcomes, and severe functional impairment compared to those with a SUD or PD alone. So, what is the link between personality disorders and substance use disorders?
What is Personality Disorder?
A personality disorder is a mental health disorder characterized by patterns of thinking, feeling, and behaving that are rigid, inflexible, and often harmful. People with personality disorders often have poor cognitive capabilities and may struggle to socialize with other people.
Personality disorders usually develop during childhood and teenage years and are primarily influenced by a person’s genes and environment. There are ten distinct types of personality disorders: paranoid, schizotypal, antisocial, borderline, narcissistic, histrionic, obsessive-compulsive, schizoid, avoidant, and dependent.
What is Substance Use Disorder?
Substance use disorder, also known as addiction, is a pattern of using alcohol or drugs (both legal and illegal) that leads to significant impairment. SUD develops with repeated or prolonged use of these potentially harmful substances and can easily become a lifelong problem.
People with substance use disorder often have no control over their cravings and, in most cases, will continue using despite negative consequences, such as poor performance at work or school, financial difficulties, relationship problems, or adverse health effects.
Personality Disorder and Substance Use Disorder – The Connection
There are several reasons why people with personality disorders are more likely to develop substance use disorders. For one, people with personality disorders often struggle with impulsivity and poor decision-making, leading to drug and alcohol abuse.
Second, people with personality disorders often have difficulty coping with stress and managing their emotions. As a result, they may turn to substance use as a way to self-medicate and numb their feelings. For example, someone with an antisocial personality disorder might turn to alcohol as a coping mechanism. In contrast, someone with a narcissistic personality disorder might abuse drugs to boost their ego and confidence.
Third, both disorders affect overlapping areas of the brain, which control reward-seeking behavior, impulsivity, and emotional regulation. This overlap could underlie the high rate of comorbidity.
Finally, personality disorder and substance use disorder also share common risk factors, such as genetic predisposition, trauma, and excessive stress, which could also explain the high co-occurrence rate.
Treating Comorbid Substance Use and Personality Disorder
If you or someone you know is struggling with a personality disorder and a co-occurring substance use disorder, it is advisable to seek professional help as soon as possible. As with any other illness, early diagnosis and treatment can make a big difference.
The most effective treatment for co-occurring personality and substance use disorders is a multi-faceted, integrated approach that simultaneously addresses both conditions. Treating one condition at a time is generally less effective as it fails to address the complex interactions between the two disorders.
In most cases, the first step in treatment is typically detoxification, which helps the patient safely and effectively withdraw from substance use. This is followed up with psychological and behavioral therapies, which aim to address the underlying personality disorder by helping the person overcome negative thinking patterns and behaviors, develop healthy coping mechanisms, and improve their social skills and relationships. Over the years, psychological therapy has also proven to be an effective tool in treating substance use disorders and may be instrumental in preventing a relapse.