Even in the best of circumstances, treating substance abuse issues is challenging and complex. Effective therapies must be holistic, meaning they take into account the particular circumstances and traits that may provide additional barriers to healing. One of the most common of these is mental illness. According to the National Institute on Drug Abuse, people suffering from mental illnesses or personality disorders are twice as likely to abuse substances. In order to overcome the dual challenges of personality disorder and addiction, it’s helpful to understand how these issues feed into one another and to attempt to untangle the knot they form.
The Intersection of Personality and Addiction
Before we can understand the effect that personality disorders have on addiction, we need to understand the effects of personality itself. While there is no one trait associated with an “addictive personality,” there are some common characteristics that can lead a person down the path of addiction. Successful treatment plans should seek to include these traits, whether or not there is an additional diagnosis of a personality disorder. Thrill-seeking and conflict avoidance, for example, are common traits to addicts but are not necessarily indicative of mental illness on their own.
Personality disorders are even more challenging. Many patients develop strong habits and dependencies in an attempt to self-medicate their mental illness, and prying apart the bond between those habits and feelings of safety is difficult. Depression, anxiety, and antisocial personality disorders are all strongly associated with addiction. The key to successful recovery lies in treating the underlying disorder alongside the addiction to keep the client from regressing back to using when their illness becomes particularly challenging.
Genetics, Mental Illness, and Addiction
Susceptibility to addiction and personality have a strong genetic component. The amount of pleasure experienced by someone when they use a drug, for instance, is controlled by their genes. Mental illness, similarly, is often genetically determined. Dopamine production (or lack thereof) is a component of depressive mood disorders and is also the response sought by an addict when they use. This connection can prove challenging, as both sources of dopamine imbalance must be treated together for therapy to be effective.
Both drug use and mental illness change the chemistry of the brain, causing a chicken-and-the-egg scenario. When mental illness symptoms are present before the client first uses, chemical deficiencies in the brain caused by the disorder can prime the client to experience more pleasure with taking drugs than would a person with a healthy brain. If drug use precedes the onset of mental illness, the exposure to brain altering chemicals can deepen the effects of the illness, making the client more susceptible to the negative effects of the disorder they suffer.
Compounding Challenges
Personality disorders add an extra layer of complexity to building a treatment plan. In the case of patients with Borderline Personality Disorder, for example, clients may lash out at their counselors or attempt to shift blame for personal issues onto them. It’s necessary to monitor for this behavior and help the client recognize the impulse, redirecting them to more sustainable and constructive coping strategies.
Antisocial clients may be manipulative and evasive one moment, guarded and retaliatory the next. Counselors frequently find clients who react in this manner particularly challenging as they tend to reject therapeutic methods more forcefully than addicts who don’t suffer from mental illness. Clients with personality disorders may also push counselors to take responsibility for their emotional health in ways that harm their recovery. Care must be taken to prevent transference. Clients need to be empowered to handle their emotions and responses in ways that don’t put them at risk of relapse.
Barriers to Treatment
Beyond the internal psychological effects that mental illnesses have on those who suffer from them, there are other consequences that may impact treatment success. According to the World Health Organization, people who have mental illness are also more likely to experience social disengagement, domestic abuse, and homelessness. As we know, these factors can also make a recovery much more difficult. An effective treatment plan must be designed to address any social or domestic factors that impede successful sober living.
Clients should be encouraged to examine their coping mechanisms and to develop strategies for dealing with difficulties within their lives in ways that do not include substances. Some personality disorders make building interpersonal relationships more difficult, which diminishes the strength of their support network. In addition to the usual strategies for developing healthy support, clients may need help unlearning social skills formed by their mental illness, such as manipulation or irrational responses to stress.
Dialectical Behavioral Therapy
Dialectical Behavioral Therapy, or DBT, is a form of Cognitive Behavioral Therapy that encourages people with personality disorders to assess their own coping strategies in terms of practicality and effectiveness. People who have been otherwise resistant to therapy can often respond to this treatment more readily. The key component of this therapy is that the view of the counselor toward the patient is one of trust and confidence that the client is putting forth their best effort.
In DBT, clients record the challenging situations or feelings they encounter during the week so the counselor can help them process each one in a healthy way. Challenges should be prioritized in tiers that denote how potentially harmful the client’s natural reaction would be to their health and recovery. Self-injurious impulses are markers of first-tier challenges. The situations that bring up these reactions should be processed first, with therapy-challenging and lifestyle-challenging reactions taking second and third priority.
Group therapy may be incorporated as well. Clients in group sessions should be encouraged to share strategies for overcoming destructive impulses and methods for dealing with stress in ways that support sobriety.
The goal of dual-condition therapies, whether they are talk-based or pharmacological, is to extend the time period between relapses, which are particularly common in clients suffering from personality disorders. This is accomplished by integrating treatments for both disorders so that the same techniques that support sobriety can also be used to support overall, ongoing mental health.