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Personality Disorders And Substance Abuse: Co-Occurring Disorders

Dr. Alan Weiner MD

Medically reviewed by

Dr. Alan Weiner, MD

April 8, 2019

Struggling from substance abuse can be a challenge. But if you or someone you know struggles with substance abuse and a personality disorder, the challenges can seem even tougher. Finding a rehab facility that treats both your substance abuse and personality disorder is key to achieving long-lasting success and recovery.

What Are Personality Disorders?

Personality disorders are mental illnesses where individuals have long-term patterns of thoughts and behaviors that are unhealthy. These thoughts and behaviors are very rigid and this creates problems with relationships, work or school life, everyday stresses, and other day-to-day interactions.

Those suffering from personality disorders often struggle with fitting into society. While the cause of personality disorders is still unknown, a person’s childhood experiences, past traumas, exposure to stressful environments, and even genes may play a role in how an individual developed the disorder.

Those suffering from a personality disorder may have difficulty understanding that they have a problem in the first place and often shift blame for their thoughts or actions onto others. From their point of view, they most likely do not see the fault in their own thoughts or actions and may even consider their behaviors normal.

This is similar to those struggling with substance abuse because many individuals suffering from substance abuse also shift blame onto others and may fail to recognize that a problem exists. Denial of a problem can pose unique frustrations for family members or loved ones who want to see the suffering individual seek help.

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Personality Disorders Have Three Diagnostic Clusters

There are ten different types of personality disorders and their symptoms range from mild to severe. According to the DSM-5 (a manual that helps psychologists diagnose patients), personality disorders can be grouped into three separate clusters known as Cluster A, Cluster B, and Cluster C.

  • Cluster A personality disorders include: schizoid personality disorder, paranoid personality disorder, and even schizotypal personality disorder.
  • Cluster B personality disorders include: borderline, antisocial, narcissistic, and histrionic personality disorders.
  • Cluster C personality disorders include: dependent, obsessive-compulsive, and also avoidant personality disorders.

Cluster A is defined as personality disorders that contain strange and bizarre or suspicious thoughts or actions. Cluster B is defined as personality disorders containing highly emotional or dramatic behaviors. And Cluster C is defined as personality disorders where individuals possess extreme levels of fear or anxiety. Traits from any personality disorder can be vague and symptoms within each cluster are similar so they tend to blend together or overlap when being diagnosed. It is possible for a patient to be diagnosed with more than one personality disorder.

Personality Disorders And Substance Abuse

Approximately 1 in 10 Americans over the age of 12 suffer from substance abuse. That means that around 23.5 million Americans struggle from substance abuse and that number is rising. Personality disorders may seem like an uncommon occurrence but they are common. It is estimated that about 15 percent of American adults (that’s about 40 million Americans) have a personality disorder.

Having a personality disorder and substance abuse can seem challenging, but these disorders can be treated effectively by correct treatment approaches and by compassionate and understanding mental health professionals that know how to treat dual-diagnosis patients.

Because those with personality disorders have a difficult time with relationships and other aspects of society, they may resort to harmful coping mechanisms. Poor coping mechanisms may include: suicide attempts, violent behaviors, psychiatric hospitalizations, and self-injury. In fact, all of these incidences are quite common for those with personality disorders. Those with a personality disorder may also suffer from depression, anxiety, and even substance abuse.

Co-Occurring Disorders

As mentioned before, having both a personality disorder and a substance abuse problem is called a co-occurring or dual-diagnosis issue, where a patient has two or more concurrent mental illnesses. In order to help an individual get the right treatment for their substance abuse it is necessary to be properly diagnosed by a mental health professional. A proper diagnosis is vital in order to get the patient the help they need and in order to find the best ways in which to treat them.

In the past, substance abuse and personality disorders were treated separately. But today, mental health professionals know that both conditions need to be treated simultaneously.

Treating those with a personality disorder can pose challenges all on their own, but not insurmountable ones. Patients with personality disorders can be rigid in their thoughts and actions and can be demanding, needy, and even hostile to their therapists. Patients with personality disorders are so ingrained in their behaviors or thoughts that professional, creative, and compassionate approaches to recovery will work best for them in the long-term.

Treatment Approaches

Treatment approaches for those suffering from substance abuse and personality disorders may include various forms of talk therapy and even the administration of certain medications. Those with a personality disorder and an alcohol or drug addiction must have intensive psychotherapy.

Treating both co-occurring disorders will be demanding and intense; however, any inpatient rehab program treating substance abuse will be intense in order to help individuals fully recover. Be sure to attend a rehab facility that has experience helping those with co-occurring disorders.

For those with a dual-diagnosis, treatment with medications is not viewed detrimentally to a person’s sobriety. Medications (such as psychiatric drugs and anti-addiction medicine) in this situation are seen as a helpful resource that can increase success rates for struggling patients when combined with comprehensive therapy.

Individuals with personality disorders and substance abuse have responded well with dialectical behavior therapy, also known as DBT. DBT is now seen as one of the most effective ways in helping individuals with personality disorders lead happy, productive, and drug-free lives. DBT teaches patients how to: cope with extremely stressful or painful emotions, practice “mindfulness” or living in the present rather than the future or past, accept themselves for who they are, and patients are also taught how to positively cope with negative feelings or overwhelming situations.

Contact Us

Suffering from a personality disorder and substance abuse may leave you feeling isolated and frustrated. But you are not alone. At, we are here to help you find the treatment approach or rehab facility that is right for you. Contact us today to start your new beginning. There is hope and we can help.

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