1. Personality Disorders and Substance Use Disorders
“What’s the connection?”

2. What is a Personality Disorder?
According to the American Psychiatric Association (APA), a personality disorder exists when an individual’s “personality traits are inflexible and maladaptive and cause either significant impairment in social or occupational functioning or subjective distress.”

3. What causes Personality Disorders?
There are various theories, but the leading ones hold that normal, healthy childhood development gets interrupted in some significant manner;
One type of scenario in which this occurs is that of abuse or neglect – including severe emotional, physical, or sexual abuse.
One perspective is that a personality disorder is like a “badge of courage” because it indicates that someone has survived much hurt.

4. Reframing the “problem” of Personality Disorders
One way to understand personality disorders is that the person coped in the best way they knew how, in response to difficult circumstances, and at that past time (typically during childhood), it helped them to survive. (i.e., ADAPTIVE)

5. Reframing the “problem” of Personality Disorders
However, those old coping mechanisms tend not to work very well in adulthood, and have become ineffective, or MALADAPTIVE.

6. What are the different types of personality disorders?
Cluster A
Paranoid Personality Disorder
Schizoid Personality Disorder
Schizotypal Personality Disorder
Cluster B
Antisocial Personality Disorder
Borderline Personality Disorder
Histrionic Personality Disorder
Narcissistic Personality Disorder
Cluster C
Avoidant Personality Disorder
Dependent Personality Disorder
Obsessive-Compulsive Personality Disorder

7. Common Characteristics of Personality Disorders
Pattern of problematic relationships
Tendency to blame difficulties on others, or on “bad luck”
A lack of personal responsibility
Impaired ability to learn from previous experience

8. Personality Disorders and Addiction
In active addiction, a person’s primary relationship is with their substance of choice – all other relationships come second to that one.
Pattern of problematic relationships

9. Personality Disorders and Addiction
Working through the symptom of “denial,” or working from a state of “precontemplation” to an “action” stage of change is one key to recovery success
Tendency to blame difficulties on others, or on “bad luck”

10. Personality Disorders and Addiction
Owning personal responsibility for actively participating in one’s own recovery is another key to recovery success (12-Step inventories & amends-making)
A lack of personal responsibility

11. Personality Disorders and Addiction
Impaired ability to learn from previous experience
“Doing the same thing over and over again, and expecting a different result” description of addictive “insanity”

12. “Cluster B” Personality Disorders
Antisocial Personality Disorder
Borderline Personality Disorder
Histrionic Personality Disorder
Narcissistic Personality Disorder

13. Antisocial Personality Disorder (3% males, 1% females)
“A pattern of disregard for, and violation of, the rights of others”
Over 30% prevalence in substance abuse treatment settings; most common with male alcoholics, “mean drunks”

14. Antisocial Personality Disorder – 3 or more traits
Failure to conform to social norms re: lawful behavior as in repeatedly performing acts that are grounds for arrest
Deceitfulness, as in repeated lying, using aliases, or conning others
Impulsivity or failure to plan ahead

15. Antisocial Personality Disorder – 3 or more traits
Irritability and aggressiveness, as in repeated assaults or fighting
Reckless disregard for safety of self or others
Consistent irresponsibility, as in repeated failure to maintain employment, or to honor $ obligations
Lack of remorse re: mistreating others

16. Borderline Personality Disorder (2%)
“a pattern of instability in interpersonal relationships, self-image”
30-60% of persons diagnosed with personality disorders end up with this diagnosis

17. Borderline Personality Disorder – 5 or more traits
Frantic efforts to avoid abandonment
Pattern of unstable/intense relationships
Unstable self-image, sense of self
Impulsivity that is potentially self-harmful
Recurrent suicidal behavior, gestures, threats, or self-mutilating behavior

18. Borderline Personality Disorder – 5 or more traits
Emotional instability, over-reactivity
Chronic feelings of emptiness
Inappropriate, intense anger or anger control problems
Transient, stress-related paranoid ideation or severe dissociative symptoms

19. Histrionic Personality Disorder (2-3%)
“a pattern of excessive emotionality and attention seeking”

20. Narcissistic Personality Disorder (<1%)
“a pattern of grandiosity, need for admiration,
and lack of empathy”

21. Goods News / “Bad” News
Unlike many other disorders that are chronic or ongoing, personality disorders are resolvable / “curable”
The process of resolving a personality disorder usually involves hard work over an extended period of time

22. Dialectical Behavior Therapy treatment leads to changes in . . .
Ways of thinking
Ways of managing emotions
Ways of relating to others
Ways of dealing with distress

23. Dual Recovery domains Thinking Emotions Dealing with others
Dealing with discomfort
Stinkin’ thinkin’
Emotional binging (ex. self-pity) can precede substance binging
Conflict / avoidance, resentments
Alternatives to using to manage distress

24. “Cluster A” Personality Disorders
Paranoid Personality Disorder
Schizoid Personality Disorder
Schizotypal Personality Disorder

25. Paranoid Personality Disorder (2.5%)
“a pattern of distrust and suspiciousness such that others’ motives are interpreted as malevolent”

26. Schizoid Personality Disorder (<1%)
“a pattern of detachment from social relationships, and a restricted range of emotional expression”

27. Schizotypal Personality Disorder (3%)
“a pattern of acute discomfort in close relationships, as well as cognitive or perceptual distortions, and eccentricities of behavior”

28. “Cluster C” Personality Disorders
Avoidant Personality Disorder
Dependent Personality Disorder
Obsessive-Compulsive Personality Disorder

29. Avoidant Personality Disorder (<1%)
“a pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation”

30. Dependent Personality Disorder (?%)
“a pattern of submissive and clinging behavior related to an excessive need to be taken care of”

31. Obsessive-Compulsive Personality Disorder (1%)
“a pattern of preoccupation with orderliness, perfectionism, and control”