Treatment for Personality Disorders and Addiction

Addiction and personality disorders often occur together. This is often called a dual diagnosis. Many studies suggest that, when compared to the general population, the predominance of personality disorders (PDs) is more significant among patients with addictions, also called substance use disorders (SUDs). This is particularly true for:

  • Antisocial Personality Disorder (APD)
  • Borderline Personality Disorder (BPD)
  • Narcissistic Personality Disorder (NPD)
  • Paranoid Personality Disorder (PPD)

At The Freedom Center in Gaithersburg, Maryland, our outpatient facility specializes in treating people with personality disorders and addiction. Here is our guide with everything you need to know, from diagnosis criteria to treatment.


personality disorders and addiction

What Is Addiction?

Addiction is defined by the National Institutes of Health (NIH) as a “chronic, relapsing disorder characterized by compulsive drug seeking and use despite adverse consequences.” It’s a brain disorder that includes changes to brain circuits involved in reward, stress, and self-control. Furthermore, it’s a lot like other diseases, such as heart disease. Both diseases:

  • Disturb the normal, healthy functioning of an organ in the body.
  • Have serious harmful effects.
  • Are treatable and preventable in many cases.
  • Can last a lifetime and lead to death if not treated.

What is a Personality Disorder?

Personality disorders are mental health disorders that affect the way you perceive and respond to the world. PDs result in long-lasting patterns, and dangerous or unusual behaviors that deviate from cultural standards. According to the latest Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), personality disorders generally feature:


  • Fixed patterns of behavior that significantly differ from the usual expectations of conduct in the person’s culture.
  • Patterns of behavior that are extensive, stubborn, and resistant to change.
  • The onset of the disorder’s features no later than early adulthood.
  • No awareness that the behavior patterns and personality features are a problem or that they are different from other people.
  • Impairment and distress in one or more areas of their life (typically only after other people get upset about their behavior).
  • Patterns of behavior that are not accounted for better by the effects of substance abuse, medication, or another medical condition such as a head injury, or mental disorder.

Learn more about the types of personality disorders below.


Antisocial Personality Disorder

An antisocial personality disorder is the adult form of a childhood disorder called conduct disorder. Individuals with these disorders show a repeated pattern of disregard for other people. This is shown by:

  • Failure to conform to social standards
  • Repeated lying
  • Impulsiveness
  • Aggressiveness
  • Violence
  • Irresponsibility
  • Lack of remorse for mistreating other people

Research indicates that first-degree relatives of people with antisocial personality disorder are more likely to develop antisocial personality disorder and SUDs.

Borderline Personality Disorder

According to research, 50 to 70% of people with borderline personality disorder, also have a co-occurring disorder. Individuals with this disorder tend to have unstable relationships and intense, uncontrolled emotions. They are also at greater risk for SUDs than the general population. Similar to many SUDs, borderline personality disorder (BPD) features:

  • Inappropriate, intense anger, frequently losing your temper, being sarcastic or bitter
  • Wide mood swings that last a few hours to a few days
  • Rapid changes in self-identity and self-image
  • Risky and impulsive behavior
  • Intense fear of abandonment
  • Suicidal threats or behavior, self-injury
  • Loss of contact with reality and periods of stress-related paranoia

Narcissistic Personality Disorder

People with this disorder have an unreasonably high regard for their importance. They require and seek too much attention and want to be admired. People with narcissistic personality disorder may not have the ability to understand or care about other people’s feelings. However, behind their mask of extreme confidence, they are not sure of their self-worth and are easily upset by the pettiest criticism. Symptoms include:

  • An unreasonably high opinion of their own
  • Need constant admiration
  • Believe they deserve special treatment
  • Exaggerate talents and achievements
  • Take advantage of others to get what they want
  • Unable or unwilling to acknowledge the needs and feelings of other people
  • Insist on having the best of everything
  • Are envious of others, and believe they are envied by others
  • Have trouble dealing with anything they see as criticism

Paranoid Personality Disorder (PPD)

Individuals with PPD always believe that others are trying to harm, demean, or threaten them. This severely limits their social lives. They may also:

  • Believe other people are taking advantage of them or lying to them
  • Hold grudges and be unforgiving
  • Be overly sensitive and take criticism badly
  • Have persistent suspicions that spouses or romantic partners are unfaithful
  • Imagine hidden meanings in innocent remarks and casual looks from others
  • Have problems relaxing
  • Be stubborn and argumentative
  • Identify attacks on their character that no one else does

Can a Person Have an “Addictive Personality?”

Contrary to popular belief, an “addictive personality” has not been identified by research. Still, some personality traits are more commonly observed in individuals with SUDs. Although most of the research surrounding addiction and personality traits has been conducted with people who have alcoholism, many of these traits are observed in people with other substance use disorders. The most common of these traits include:

  • Nonconformity
  • Impulsiveness
  • Thrill-seeking behavior
  • Unregulated emotions
  • Negative affect (depression, anxiety)
  • Low self-esteem
  • Not taking responsibility for actions

How Do Personality Disorders Affect Addiction?

Personality disorders usually begin during adolescence or early adulthood. When personality disorders and addiction co-occur, the personality disorder is normally diagnosed first because people frequently use drugs or alcohol to treat the symptoms of their mental health disorder.

However, addiction may be diagnosed before personality disorder in some cases. Eventually, self-medicating to treat personality disorder symptoms can lead to addiction. As the addiction develops and the drug abuse gets worse, the severity of the personality disorder can also increase.

Treating Personality Disorders and Addiction

People showing symptoms that happen repeatedly and cause substantial impairment in functioning should see a mental health expert for an evaluation before starting addiction treatment. Individuals with undiagnosed or untreated personality disorders are less likely to maintain their sobriety after addiction treatment.

In general, the clinical treatment and outlook of SUDs are different when a co-occurring PD is present. Patients with co-occurring personality and SUDs tend to have:

  • An earlier start of substance use problems,
  • More severe problems with dependence,
  • More frequent use of other drugs,
  • Lack of motivation to change,
  • Increased risk of suicide, and
  • More dropouts from treatment.

The Key to Recovery

Treatment that addresses both issues simultaneously is the key to recovery.  But, treating co-occurring substance use and personality disorders can be a complicated process. It’s often difficult because of the complexity of the disorders and the relationship between them. Many symptoms of PDs overlap with those of SUDs and, in some instances, one disorder can stay undetected.

The first step toward a successful recovery is getting help from a qualified treatment professional. It’s vital to find professionals who have experience treating people with addiction and co-occurring personality disorders. The most effective method is to treat both disorders at the same time.

The Team

This may involve multiple specialists who work together as a treatment team.  Team members may include a:

  • Primary care provider
  • Group therapist
  • Individual therapist
  • Psychiatrist
  • Substance abuse counselor

Experts on the team need special skills to connect effectively with people who have co-occurring disorders. Among people with personality disorders and addiction, dropout rates are high. Patients frequently end treatment because of a difficult or failed relationship with their therapist. Research has shown that dual-diagnosis treatment programs can give support and effective management that improves outcomes and motivates patients to continue their treatment.

In addition, individuals diagnosed with these disorders often resist treatment. They are much more likely to stop treatment earlier than those without PD. Combining appropriate treatment and therapy groups can help motivate them to stay in treatment.

What is the Treatment for These Co-Occurring Disorders?

Studies have suggested that the most promising treatment approach for co-occurring disorders in behavioral therapies such:

  • Cognitive-behavioral therapy (CBT)
  • Dialectical behavior therapy (DBT): A dynamic psychology approach that helps the person understand their underlying thoughts and feelings.

An effective dual-diagnosis recovery treatment program combines inpatient and outpatient addiction treatment with therapies and treatments that address the person’s personality disorder. This way, they are educated about addiction and the problems that come from self-medicating with alcohol or drugs.

Our treatment facility focuses on fostering a strong relationship between therapists and their patients. This provides patients with stability and trust during periods of emotional hardship. The families of people dealing with addiction and a personality disorder can also help by working with their family members during treatment to help repair damaged relationships.

By providing an environment where the individual’s family and loved ones can learn the necessary skills, the treatment professionals can help family members improve relationships and provide continued support.

Preventing Relapse After Treatment

The chance of relapse for people with a dual diagnosis is high. And a relapse can cause people to fall back into dangerous situations and behavior patterns. Sadly, the risk of suicide among people with co-occurring personality and substance use disorders is also high. Many individuals see suicide or self-harm as a method to deal with difficult emotions.

It is vitally important to avoid these types of risks by continuing treatment after achieving sobriety. Online support communities, 12-step meetings, and group therapy can be great benefits for people who need continuing support after completing formal treatment. Families can also use support groups for additional support resources.

Let The Freedom Center Be Your Recovery Team

If you’re struggling with addiction, you may very well be also suffering from a personality disorder. Our team of professionals is prepared to guide you through the treatment necessary for long-term recovery.

We know that everyone needs and deserves a treatment program designed specifically for them and that’s why our treatment programs include:

  • Residential Inpatient Treatment: In a residential program, you will live at the treatment facility so you can focus on your recovery with no outside distractions or triggers.
  • Partial Hospitalization Treatment (PHP): PHP is also called day treatment. You spend full days at the facility, 5 to 7 days per week, and go home in the evening. Although it’s technically an outpatient program, it compares to residential in intensity.
  • Intensive Outpatient Program (IOP): The IOP requires you to attend sessions at the facility 3 to 5 days per week for about 3 hours per visit.
  • Outpatient Program (OP): In a standard outpatient program, you attend treatment sessions several hours per week.


Dual Diagnosis Program at The Freedom Center

The professionals at The Freedom Center are thoroughly qualified to treat individuals with co-occurring disorders. We understand the complicated relationship between personality disorders and substance use disorders and will provide you with a team of specialists dedicated to helping you recover. Untreated disorders don’t go away on their own. Contact us today and start on the road to your freedom.

Break Free From Addiction

At our substance abuse treatment center in Maryland, we do our best to meet each individual where they’re at. Each person comes with a different mold - a different struggle. The best way we can help them is to offer them care that is unique to their own situation; there is no one-size-fits-all method to substance abuse treatment. This is why individualized care is so important to us. If you or a loved one are interested in finding out more, you can contact us here.
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