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.
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