Tag Archives: Coping Skills

Comorbidity of Personality Disorders and Substance Abuse Disorders


There are an estimated 44%-60% of people who have been diagnosed with substance use disorder who also qualify with symptoms pertaining to a minimum of one personality disorder.  Personality disorders include antisocial personality disorder, avoidant personality disorder, borderline personality disorder, obsessive-compulsive personality disorder and schizoid personality disorder.  Each of these personality disorders have their own symptoms and characteristics, but generally speaking any personality disorder affects people cognitively, which is the way people look at themselves and the world in general, affectation, which is the level of reaction to any one thing, as well as interpersonal functioning and the level of impulse control a person has.  A person can suffer from mood swings, anger outbursts or alcohol or substance abuse.

A person who is diagnosed with a personality can also have a second diagnosis of substance abuse disorder.  This is defined as:

 

 

 

 

 

 

“A complex behavioral disorder characterized by preoccupation with obtaining                     alcohol or other drugs (AOD) and a narrowing of the behavioral repertoire towards          excessive consumption and loss of control over consumption.  It is usually also           accompanied by the development of tolerance and withdrawal and impairment in social and occupational functioning.” (www.cdad.com)

A patient must present with certain symptoms in order to be diagnosed with substance abuse disorder, the symptoms are the behaviors someone would expect from anyone with a substance abuse disorder, but they are not usually so obvious to the patient.  The symptoms include a tolerance of the substance or a need for more and more of the substance because it is harder and harder to feel the effects of the substance, withdrawal when the substance is not used on a regular basis, the substance being used for longer than the patient thought they would be using it for, the patient having a continuous desire to control the habit of using the substance but is unsuccessful at doing so, the patient spending a lot of time trying to find or use the substance or coming off of the substance, the patient giving up activities in multiple areas of their life in order to have the opportunity to use the substance, and continuing use even though it is causing health problems to the patient.

The diagnosis of substance abuse disorder comes about when the patient has become increasingly more tolerant and dependent on their chosen substance.  After the body becomes accustomed to having that substance available on a regular basis, the body will react with withdrawal symptoms which can include headaches, insomnia, and hallucinations and could include aggression, paranoia or promiscuous behavior.  Most patients live in denial when it comes to admitting they have a problem and have to get past that denial in order for any type of treatment to help them.

When a patient is diagnosed with both of these disorders at the same time it is considered co-morbidity of substance abuse disorder and personality disorder.  A little over half of patients who have been seen for substance use disorder have also been diagnosed with a minimum of one personality disorder.

There are two treatments that have been established for this type of co-morbidity.  One is called dual focus schema therapy and it combines different life skills such as functional analysis and coping skills training.  This treatment involves 24 sessions and plans for two stages.  The first of these stages is called early relapse prevention and helps the patient develop life skills that will aid the patient in dealing with temptation or actual relapses.  The second stage is called schema change therapy and coping skills work, this stage helps the patient make the changes more concrete and helps the patient develop methods for coping once abstinence is achieved.

Looking at co-morbidity of substance abuse and personality disorders has shown how difficult it can be to diagnose a patient with multiple disorders, especially when it involves substance abuse because substance use is so common and it seems there really is a fine line between the two.

References

Netherton, S.D., Holmes, D., Walker, C.E. (1999). Child and Adolescent Psychological Disorders.  New York, NY: Oxford University Press.

(Retrieved 2009, October 28). Co-occurring Mental Health and Substance Abuse Disorders. www.dshs.wa.gov.com.   http://www.dshs.wa.gov/pdf/hrsa/mh/cobestpract.pdf

(Retrieved 2009, October 28). Axis II Personality Disorders and Mental Retardation.  Psyweb.com.   http://psyweb.com/Mdisord/DSM_IV/jsp/Axis_II.jsp

(Retrieved 2009, October 28). Frequently Asked Questions (FAQ’s) About Substance Abuse Disorders.  www.cdad.org  http://www.cdad.org/FAQSubstanceUseDisorders.htm

Quick Definition of Mental Health


In looking at mental health criteria I came across this definition.  From an article in the Encyclopedia of Public Health, titled Mental Health says:

Dianne Hales & Robert Hales define mental health as the capacity to think rationally and logically, and to cope with the transitions, stresses, traumas, and losses that occur in all lives, in ways that allow emotional stability and growth.  In general, mentally healthy individuals value themselves, perceive reality as it is, accept its limitations and possibilities, respond to its challenges, carry out their responsibilities, establish and maintain close relationship, deal reasonable with others, pursue work that suits their talent and training, and feel a sense of fulfillment that makes the efforts of daily living worthwhile.  (Rosenfield, 2002, p. 2)

I think this definition supports what is written in the “Psychopathology Defined in Context” because in this document one requirement of mental health is “being able to function comfortably on a day-to-day basis”.  I understand these definitions to mean that a person who is mentally healthy will be able to progress in life within what is understood to be normal limits.  They will not have any extreme stressors that cause them to stop their mental growth because they will be able to deal with any stressors they come across productively.

This document also mentions four dimensions in which to look at mental health.  In taking a look at these dimensions, and an article from the Mayo Clinic titled, Mental health: What’s normal, what’s not, I was able to identify and recognize them.  The dimension of comfort and discomfort are, when you are comfortable, your behaviors, feelings, and thoughts are within what is considered ‘normal range’.  Excessive behaviors such as cleaning even when there is nothing to clean, or feelings that don’t seem to go away would make a person uncomfortable.  Another example of discomfort would be abnormal thoughts.  Abnormal thoughts would include believing something is controlling you, or considering killing yourself.

The next dimension mentioned in the document is efficiency and inefficiency.  All of the actions mentioned above would also demonstrate this dimension.  If the symptoms are severe enough or uncomfortable enough they would disrupt any kind of routine a person has in place, thus, causing everything to take longer or to not happen at all.

The third dimension is potential and actual.  The disruption of a mental illness causes any potential growth to cease.  Many times the person does not realize this and believes things are very different than what is actually happening.  The person’s perception is often a key factor in determining the correct treatment.

The final dimension is acculturation and bizarreness.  When a person’s behavior becomes disruptive or is considered to be out of the norm, other people’s perceptions can be used to help determine what diagnosis is appropriate.  This could be useful when the person does not see anything wrong with the way they are behaving.

Hopefully this quick look at the different dimensions of mental health will aid in the search for information on this topic.

References

Rosenfield, Paul J.; Stuart J. Eisendrath. “Mental Health.” Encyclopedia of Public Health.The Gale Group Inc. 2002. Retrieved September 02, 2009 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3404000537.html

Mayo Clinic Staff. (2009). “Mental health: What’s normal, what’s not.” Retrieved September 02, 2009 from MayoClinic.com: http://www.mayoclinic.com/health/mental-health/MH00042