Understanding, Not Blame: Personality Disorders and Addiction

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There are many components that impact the development of a substance use disorder. Among those components, we often see underlying personality disorders -- including but not limited to narcissism, borderline, histrionic, or antisocial. Although these personality disorders do not cause an addiction, they can fuel the addictive process because people often turn to alcohol and drugs in order to alleviate negative symptoms associated with these disorders.

Narcissism, borderline, histrionic, and antisocial personality disorders typically develop when an individual avoids emotion and is unable to deal with uncomfortable feelings. The brain gradually becomes impaired and no longer regulates emotion. A person may turn to drugs or alcohol or other behaviors (e.g. sex, video games, food) to cope with this emotional deficit. As they continue to self-medicate with substances, the addiction progresses and the behavior results in damaging consequences – inability to maintain a healthy relationship, lying, cheating, stealing, conning, manipulation, violence, or general self-harm.

Research shows that childhood trauma may play a significant role in the development of personality disorders. These behaviors may have helped them survive a difficult environment, but they morphed into a destructive force. Trauma reflects a wide range of experiences such as growing up with an alcoholic parent or experiencing emotional, physical, or sexual abuse.

For patients with these disorders, it’s critical to address the behaviors associated with them as part of a comprehensive treatment plan. As with all mental health and substance use disorders, medical and psychiatric staff must be integrated into a clinical treatment team from the very beginning to observe behavior, collect personal history from the patient and loved ones, and administer testing. Proper diagnosis is key to developing a tailored disease management plan that incorporates behavioral modification strategies that address personality disorders .

It is important for individuals with diagnoses of personality disorders or that display traits of these disorders to avoid blaming, shaming, labeling, or stigmatizing themselves and seek appropriate treatment. Family members who observe these traits should also be careful not to blame, shame, label or stigmatize their loved one. Individuals and families must also get information about personality disorders from a trusted and knowledgeable source. Pop culture throws around a lot of wrong ideas about personality disorders, such as narcissism.

People may also display traits of these disorders without meeting the criteria for the diagnosis, so the focus is on dealing with the traits and resulting behaviors, with or without the diagnosis – it is not as important that a person accept the label or the diagnosis as it is to treat the behaviors and the underlying issues.

It may be difficult for families to accept that, just as with substance use disorders, there is no cure for personality disorders. However, they are treatable, and treatment may result in positive outcomes. Family members can develop healthy coping tools and create structure and boundaries, to take care of themselves and hold those in recovery accountable.

The diagnosis of a personality disorder should not be taken as an excuse for dysfunctional behaviors. Instead, it’s an opportunity for both the patient and the family to understand the underlying source of the substance use disorder and begin the process of developing strategies to support overall wellness. And, as with all mental health issues, personality and substance use disorders, treatment outcomes are strongest when families are educated and involved in the therapeutic process.

Ultimately, people with personality disorders will need ongoing support for these issues well beyond residential treatment. From an early age, the behaviors were deeply engrained in their brain and require daily management to address. In the end, there is hope. We encourage a focus on progress and not perfection. With the right guidance and strategies for behavior change, an individual with a personality disorder can lead a fulfilling life.

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