The 1970s and 1980s saw a major expansion of drug use in America. In response, psychosocial researchers tried to pinpoint the problem and work toward solutions. By studying various characteristics of drug users, including personality and personality disorders, scientists tried to find which factors promoted risk of addiction and which promoted resilience. Some of this work fueled stereotypes about the moral fiber of addicts, and led some to blame drug users for falling prey to the wealthy, international drug syndicates’ crimes.
Today, understanding addiction as a brain disease that takes away self-control over behavior has helped to separate addictive behavior from personality traits. Individual personalities before drug use are very different from those under the influence, and most personalities return to baseline when the drug is discontinued. Still, underlying personality disorders may exist, whether or not a person has a substance use disorder or not.
Zimmerman and Coryell were famous for their work on personality disorders and reported in 1989 that about 43 to 77 percent of those with personality disorders also had alcohol use disorder at some point during their lives. In the 1990s, Verheul and colleagues looked at things from the opposite perspective. They found that 44 percent of people with alcohol use disorder and 77 percent of people with opiate use disorder would meet the criteria for a personality disorder as well. Specifically, the personality disorders most often found with substance use were antisocial and borderline.
Antisocial and borderline personality disorders are only two of 12 defined by the American Psychiatric Association’s 2013 publication of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). The DSM-5 describes a personality disorder as “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment.” Other types include paranoid, schizoid, histrionic, narcissistic, dependent, avoidant, obsessive-compulsive and others. When a person has a substance use disorder and a personality disorder or other severe mental illness, he or she is considered to be a “dual diagnosis.”
Data published in 2004 from the National Epidemiologic Survey on Alcohol and Related Conditions revealed that about 15 percent of adult Americans have a personality disorder. The National Comorbidity Survey Replication Study reported 9.1 percent in 2007. With a population of 320 million today, that would be about 20 to 50 million people with personality disorders. Substance use disorders are also very prevalent and reaching epidemic proportions. Estimates from the 2013 National Survey on Drug Use and Health revealed about 25 million using illicit drugs and 60 million with drinking problems. Of those who needed treatment for substance abuse, only 2.5 million received help at specialized centers.
Treatment for personality disorders is difficult, but strategies and new therapies have been developed, but are only available at specialized centers. With the extremely high numbers of people suffering from personality disorders, substance use disorders and dual diagnosis, more public health awareness is needed. Certainly the stigma of needed treatment should not be a problem, since it appears that at least 1 out of every 5 people need it.
Delaying treatment when substance use is occurring only ensures more negative consequences and outcomes. Symptoms of underlying mental illness can fuel substance abuse in an effort to “self-medicate” feelings of despair, but only serves to make despair even worse. Perhaps this helps to explain why dual diagnosis patients and those with personality disorders are at particular risk for suicide.
Most people who are active in their addiction to drugs and/or alcohol exhibit symptoms of personality disorders. Complete detoxification in a safe and comfortable environment followed by a comprehensive diagnostic assessment is needed before a diagnosis of personality disorder or dual diagnosis can be made. Only then can meaningful treatment begin to address the problem and treat actual underlying issues appropriately.
Sovereign Health of California treats individuals with substance abuse, mental health problems (including personality disorders) and dual diagnosis. We use state-of-the-art diagnostic assessment and treatment to provide optimal long-term outcomes. Comprehensive treatment and ongoing aftercare provide the support patients need to recover from addiction and all of its consequences. To find out more about specialized programs at Sovereign Health, please call us through our 24/7 helpline.
Dana Connolly, Ph.D., is a senior staff writer for the Sovereign Health Group, where she translates current research into practical information. She earned her Ph.D. in research and theory development from New York University and has decades of experience in clinical care, medical research and health education. The Sovereign Health Group is a health information resource and Dr. Connolly helps to ensure excellence in our model. For more information and other inquiries about this article, contact the author at firstname.lastname@example.org.