Identifying and Treating Personality Disorders and Substance Use
When a person struggles with both addiction and a personality disorder, treatment becomes more complex. These co-occurring disorders often feed into each other, creating a cycle that can feel impossible to break without professional help. At Emerald Isle Health & Recovery in Surprise and Sun City, Arizona, we understand these challenges and offer comprehensive treatment programs designed to address both conditions simultaneously.
What Are Personality Disorders?
Personality disorders are characterized by unhealthy patterns of thinking, functioning and behaving that differ significantly from cultural norms or expectations. Unlike passing mood changes or emotional responses to specific events, personality disorders are long-term conditions that affect how someone perceives themselves and others.
These disorders typically emerge during adolescence or early adulthood and remain stable throughout a person’s life. Many people with personality disorders don’t realize they have a problem because their thought patterns feel natural to them. Unfortunately, these patterns often lead to difficulties in relationships, work environments and social situations.
The fifth edition of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5) recognizes ten distinct personality disorders, grouped into three clusters:
- Cluster A (Odd or eccentric): Paranoid, schizoid and schizotypal personality disorders
- Cluster B (Dramatic or emotional): Antisocial, borderline, histrionic, and narcissistic personality disorders
- Cluster C (Anxious or fearful): Avoidant, dependent, and obsessive-compulsive personality disorders
People with personality disorders often turn to substances to cope with their symptoms and feel “normal” in social situations. This strategy of self-medication can quickly develop into problematic drug or alcohol use and full-blown addiction, creating a challenging scenario.
Personality Disorders That Are Frequently Seen Alongside Substance Use
While any personality disorder can co-occur with addiction, certain types are more strongly associated with addiction. Research shows that borderline personality disorder and antisocial personality disorder are most frequently diagnosed alongside substance use disorders.
Borderline Personality Disorder (BPD)
We’ve all experienced days where it feels like we’re on a roller coaster — our emotions are all over the place and we’re quick to anger, or maybe we’re unsure of how to act in certain roles. For most of us, these feelings are temporary and the moment passes. But for those with borderline personality disorder, volatile mood swings and a blurred sense of self are the norm.
The connection between BPD and addiction is significant. Research suggests that up to 78% of people with BPD will develop a substance use disorder at some point in their lives. Those with this disorder often experience intense emotions, difficulty coping with stress and a fear of abandonment. Alcohol and drugs can temporarily numb these painful feelings, making substance use an appealing but ultimately harmful coping mechanism.
Antisocial Personality Disorder (ASPD)
Antisocial personality disorder involves a pattern of disregarding the rights of others, often accompanied by behaviors like deceitfulness, impulsivity, aggressiveness and a lack of remorse. This disorder is particularly common among individuals with addiction issues.
People with ASPD often begin experimenting with drugs or alcohol at an early age. Impulsivity and risk-taking can lead to dangerous patterns of substance use, while antisocial traits may make it difficult for these individuals to recognize the negative impact of their addiction.
The combination of ASPD and substance use creates significant challenges for treatment. People with this dual diagnosis may resist following rules in treatment programs, struggle with honesty, and have difficulty connecting with therapists or peers in group settings.
Other Personality Disorders That Co-Occur With Addiction
Though borderline and antisocial personality disorders have the strongest connection to substance use disorders, other personality disorders frequently co-occur with addiction as well.
Histrionic Personality Disorder (HPD)
People with histrionic personality disorder have an excessive need for attention and often behave dramatically or inappropriately to get it. This can lead to substance use in social settings as a way to stand out or feel more comfortable being the center of attention. For these individuals, drinking or using drugs may begin as a social activity but gradually develop into dependence as they come to rely on substances to maintain their desired persona.
Avoidant Personality Disorder (AVPD)
Avoidant personality disorder is characterized by extreme shyness, feelings of inadequacy and a heightened sensitivity to rejection. People with this disorder may use drugs or alcohol to reduce their social anxiety and function in situations that would otherwise feel overwhelming.
Paranoid Personality Disorder (PPD)
Those with paranoid personality disorder experience pervasive feelings of distrust and a deep-seated suspicion that others are out to get them. This constant state of hypervigilance can be exhausting, leading some to use drugs or alcohol to relax or quiet their racing thoughts.
What Is the Difference Between a Personality Disorder and Mood or Anxiety Disorders?
While both can impact emotions and behavior, personality disorders and mood disorders differ fundamentally. Personality disorders are more rigid, involving long-standing patterns of behavior and deeply ingrained beliefs or ways of thinking that affect how someone relates to others. These patterns typically emerge in adolescence and remain relatively stable throughout life.
Anxiety and mood disorders, on the other hand, primarily affect emotional states and are often episodic in nature. Conditions like depression or bipolar disorder may come and go or vary in intensity, while personality disorders are more pervasive. For example, someone with social anxiety disorder may experience intense fear in certain social situations (such as when meeting new people), but they are aware these feelings are irrational. In contrast, a person with avoidant personality disorder holds an internalized belief that they are unworthy or inadequate and assumes that others believe the same, so they withdraw from most social situations.
Treating Personality Disorders & Addiction at Emerald Isle
Treating co-occurring mental health concerns requires a specialized approach. At Emerald Isle Health & Recovery, we understand that each condition influences the other, so effective treatment must target both the substance use and the underlying personality disorder.
Effective treatment typically includes a combination of therapies tailored to the specific personality disorder. Dialectical behavior therapy (DBT) has shown particular success for those with BPD, helping patients develop skills to regulate emotions, tolerate distress, improve relationships and stay present in the moment instead of turning to substances. For AVPD, evidence-based approaches that emphasize consequences and personal responsibility tend to be more effective. Cognitive behavioral therapy (CBT) can help patients identify and change dysfunctional patterns of thinking while developing healthier ways of interacting with others. Often, these concepts may be combined for a schema-focused therapeutic approach.
At Emerald Isle, our trained professionals performed detailed assessments that evaluate both substance use history and mental health symptoms, allowing us to identify the core challenges faced by each patient and develop personalized treatment plans. Our dual diagnosis treatment programs incorporate features specifically designed for personality disorders, including:
- Extended treatment duration since personality traits take longer to modify
- Strong focus on developing healthy coping skills to replace substance use
- Emphasis on building structure and consistency
We also recognize that recovery doesn’t end when formal treatment concludes. Our aftercare planning includes ongoing therapy recommendations, support group connections and strategies for managing both addiction and the challenges of living with a personality disorder in daily life.
Recovery Is Possible with the Right Support
Living with both a personality disorder and substance use disorder may feel overwhelming, but recovery is possible with proper treatment. At Emerald Isle Health & Recovery, we’ve helped many patients with co-occurring disorders rebuild their lives and develop healthier ways of coping with their symptoms.
If you or someone you love is struggling with addiction and symptoms of a personality disorder, don’t wait to seek help. Our compassionate team is ready to guide you through every step of the recovery process. Get started by calling us today at 855-605-0644 or completing our online contact form. The path to healing begins with a single step.
