Personality Disorders and Substance Abuse Treatment

One of the most strenuous obstacles in life to deal with is having personality disorders and substance abuse at the same time. Personality disorders come in a range of different clusters. They can have negative effects on a person’s well-being and perception, and they can take an emotional toll on their friends and families.

What are Personality Disorders?

According to the fifth version of Diagnostic and Statistical Manual for Mental Disorders (DSM-5), personality disorders are conditions in which patients experience “significant impairments in themselves and interpersonal functioning.” To be diagnosed with a personality disorder, a patient must show steady and consistent symptoms over a set time. These symptoms must be held separate from a patient’s accustomed development or as a result of the patient’s living situation. Personality disorders also can’t be the immediate outcome of a medical issue or a substance use disorder. 

What are the Different Types of Personality Disorders?

According to DSM-5, there are three classifications (Cluster A, B, and C) within the 10 contrasting categories of personality disorders.

Cluster A

Cluster A is called the strange, unconventional cluster. These disorders are characterized by eccentric or strange behavior and thinking.

Paranoid Personality Disorder

This condition is distinguished by a compulsive mistrust of others, even family members and friends. The individual is constantly skeptical and will misrepresent encounters to validate how they feel. People with paranoid personality disorder tend to project or attribute unbecoming feelings and thoughts onto their loved ones. 

Schizoid Personality Disorder 

People with this disorder are disconnected and disengaged to the point that they’re selfishly driven. Such individuals have no aspiration for close and personal social relations. They are not interested in the cultural norms or expectations of life, nor do they present emotional responsivity.

Schizotypal Disorder

This entails uncommon appearance, articulation, and actions; abnormal insight of ordinary encounters; unanticipated belief patterns. This process presents through bizarre theories, suspicion, and consuming concepts. They tend to avoid social interaction and feel that those around them are dangerous. While people with schizoid have no interest in social engagement, schizotypal people diligently dread meeting new people. People with schizotypal have a greater likelihood of developing schizophrenia later in life.

Cluster B

Cluster B is called the pronounced, unpredictable cluster. Disorders in this cluster are characterized by overly emotional and unpredictable behavior or thinking.

Antisocial Personality Disorder 

This disorder is notorious for how it brings about meanness. This disorder occurs more in men than it does in women. People with antisocial personality disorder hold no regard for social customs. More often than not, these patients are destructive, highly impulsive, stubborn with their actions, and have no shame for their behavior. Individuals with this 2disorder have a lengthy prison history and usually have criminal records. 

Borderline Personality Disorder 

People with BPD normally struggle with their sense of self, so they end up feeling desolation and desertion. They end up having passionate and exceptional relationships that are common but short-term due to their psychological unpredictability, aggressive tantrums, and suicidal threats. The old theory of the term “borderline” is based on the disorder being on the verge of psychotic and neurotic disorders. According to Psycom, borderline personality disorder is the result of childhood sexual abuse. 

Histrionic Personality Disorder

People with this disorder strive for acceptance and recognition. In turn, that is how they base their well-being, utilizing their exaggeration to uplift their self-esteem. This act will present itself in several ways, including unprofessional attentive actions or an all-consuming interest in appearance. Manipulation and exploitation present themselves in these patients due to their impulsive character nature. Their relationships tend to be superficial because the individuals are afraid of criticism and rejection isn’t processed constructively.

Narcissistic Personality Disorder

Patients have a dramatic sense of self, feeling that they are owed the appreciation of others. These individuals have jealousy towards other people, which assumes that those same people will also be envious of them. Most often than not, people with this disorder will willingly lie to get what they want and don’t have sympathy for anyone else’s feelings. 

Cluster C

Finally, Cluster C is for those struggling with fear and anxiety. 

Avoidant Personality Disorder

Patients with this condition feel they are undesirable or socially awkward, and this leads to an irrational fear of rejection. The only time these individuals will encounter other people is if they are self-assured of approval, and this behavior transfers to their personal relations. These patients have most likely faced insulting disapproval which demonstrated as avoidance and anxiety later in their life. The struggle lies in participation and engagement of social interactions because they are extremely aware of the variation of their own responses. The higher the realization, the more inadequate they feel. 

Dependent Personality Disorder 

personality disorders and substance abuse

Individuals have an intense necessity of being taken care of by other people to the extreme of making crucial choices or just everyday items. There is a hopeless horror of being deserted, born from their own view of insufficiency. They in turn put their caregivers on a pedestal, gaining from them reassurance and influence. These individuals don’t have any idea of any type of responsibility for their personality, so they come across as juvenile and incapable. They don’t have a healthy unbiased understanding of their strengths and shortcomings. 

Anankastic (Obsessive-Compulsive) Personality Disorder 

Patients with this disorder are known to have an excessive obsession with perfectionism. This need is so severe that it hinders their ability to perform. They are incredibly interested in lists, organization, details, order, and committing themselves to destructiveness to relationships and rest. Their anxiety stems from the notion that they lack control over the world, so they in turn overreact with what they can control. 

How Do You Treat Personality Disorders?

The fact that many patients have intense thoughts and views on what they believe can make treatment feel like a burden. They’re more likely to refuse to accept that they have a disorder in the first place. An example would be a patient with borderline personality disorder who can be aggressive and needy with the therapist they are seeing. 

Patterns are going to be one of the biggest hurdles while attempting to instill profound psychotherapy sessions. According to PubMed, dialectical behavior therapy (DBT) has been a popular treatment for patients with personality disorders. There are more opportunities for treating patients with co-occurring substance use disorders through cognitive behavioral therapy. 

The Link Between Personality Disorders and Substance Abuse

The European Psychiatry article from 2017 “The Relationship between Personality and Substance Abuse Disorders” states that the presence of personality disorders seems to increase the chances of developing a drug addiction. Between 65 and 90% of patients assessed for substance abuse at least have one co-occurring personality disorder. There seems to be an overlap between Cluster C disorders and alcohol dependence, and illegal drugs like cocaine. 

Although substance abuse doesn’t cause personality disorders, addiction plays a part in their development and effects. According to Innovations in Clinical Neuroscience, there are numerous borderline personality disorder patients, 66% diagnosed with a psychological dependence on alcohol, drugs, or both. On the other hand, according to the National Institute on Alcohol Abuse and Alcoholism, people with hostility and lack of empathy referring to antisocial personality disorder have higher rates of alcoholism and alcohol abuse than the common population. 

Why is Dual Diagnosis Treatment Important?

If not treated simultaneously, co-occurring personality disorders and substance abuse can make recovery more difficult. This leads to a poor outcome and a greater risk of negative consequences. According to NAMI, out of the 21 million people in the U.S. with a substance use disorder, 8 million also live with a mental illness. At Chapel Hill Detox, we offer specific treatment for patients struggling with dual diagnoses. 

What are Treatment Options for Personality Disorders and Addiction?

Due to co-occurring disorders being a complex matter, we specialize in multiple therapies to assist our patients. Different types of therapies must be used to meet each individual needs. Before treatment is applied to our patients, they participate in medical detox.


One of the first and main steps of treatment is medical detox. This act should not be viewed lightly or done alone. Medical professionals are vital in assisting with the withdrawal symptoms that arise with abruptly stopping the substance use. We make sure to provide methods to make this transition as comfortable as possible.

Individual Therapy

Individual therapy is a needed step in treatment. Therapists take advantage of the power of talk therapy to contemplate and examine a patient’s emotions, behavior, and challenges. The therapy necessary for dual diagnosis is one-on-one therapy. The takeaway from engaging in individual therapy is the learning of self-discovery and the addiction that takes place.

Group Therapy

Group therapy is an extremely valuable asset for treating co-occurring disorders. This type of therapy generally includes a licensed therapist and a group of two or more individuals. Group therapy intends for patients to assemble to acknowledge others’ struggles, emotions, perspectives, and experiences. As a result, each individual is challenged for their communication skills to be heightened and coping skills to be improved.

Inpatient/Outpatient Treatment

Inpatient rehab provides a sense of community for individuals experiencing struggles with a substance abuse disorder. Chapel Hill Detox offers care many opportunities at the facility. An outpatient rehab differs from an inpatient because the patients live at home while receiving treatment. 

Find Help at Chapel Hill Detox Today

Recovery is a long but necessary journey. Receive support and treatment for personality disorders and addiction today. Chapel Hill Detox can assist with the path to sobriety. Reach out to us for more information.