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Co-Occurring Personality Disorders and Substance Use

The most common forms of personality disorders that co-occur at a high rate with substance abuse include avoidant personality disorder, antisocial personality disorder, borderline personality disorder, and paranoid personality disorder. Historically, researchers determined that personality disorders typically cause the development of a substance use disorder. This is often because these disorders cause a change in an individual’s moods, behaviors, patterns of thinking, and relationships with other individuals.

Why Personality Disorders and Substance Misuse Co-Occur

Studies have shown that almost 60% of people who sought treatment for a substance abuse disorder were actually also suffering from a personality disorder. Addressing personality disorders, especially when in conjunction with substance abuse, can be extremely frustrating. Though there is not technically a difference between the rate of personality disorders in men and women, the diagnosis and treatment of these individuals are highly disproportional. Women are more likely to seek treatment for symptoms of these disorders through therapy because it is more socially acceptable. Women are more able to reach out for help concerning substance use too which is why there is a “higher rate” of women with these comorbidities. 

Men, on the other hand, are more likely to end up incarcerated or dealing with the law because of substance abuse, which is a side effect of personality disorders. Rather than receiving a correct diagnosis and treatment that addresses both conditions, these individuals will be reprimanded or treated solely for substance abuse which does not treat the entire problem and may lead to a relapse.

Substance Abuse and Co-Occurring Personality Disorders

Substances Commonly Used

In general, studies have seen that around 50% of people with personality disorders will struggle with a lifetime occurrence of substance abuse. Most of these individuals abuse alcohol at 35%, cannabis at 25%, and cocaine at almost 10%. There is also about an 8% rate of men and women combining different substances. Conversely, of people dealing with substance abuse disorders, about 29% struggled with borderline personality disorder, 22% with avoidant personality disorder, and 4% with antisocial personality disorder.

When it comes to addressing why people with personality disorders abuse drugs and alcohol, we have to look at the specific disorder and how it affects the brain. In many cases, these disorders cause an individual to participate in risk-taking behaviors that the person wouldn’t otherwise participate in if it weren’t for the personality disorder. These conditions can be genetic or can develop due to childhood trauma and may make a person more prone to violence, mood swings, and impulsivity. This impulsivity and increased rate of risk-taking often involve both sexual promiscuity and drug use to either enhance certain experiences and moods or to try to diminish those symptoms.


Though we know that individuals who suffer from personality disorders are at a higher risk for abusing alcohol, studies have also shown that the diagnosis of a personality disorder can actually indicate an individual’s specific risk for developing alcoholism. Many of these factors are genetic, so clinicians can actually look into their client’s family history to pinpoint risk factors and methods of treatment. 

About 29% of people who struggle with an alcohol use disorder also suffer from a diagnosed personality disorder. Though this does not account for the vast majority of people who don’t seek treatment for either, it provides us with a good idea about how often these two conditions co-occur. Some of the problems that take place with individuals dealing with both conditions include a shorter time between recovery and relapse, an increased number of days of heavy drinking, and poorer outcomes when the two conditions weren’t treated at the same time.

Personality Disorder


One study looked at the number of individuals who deal with personality disorders and have been admitted to a program for criminal activity pertaining to drugs. 71% of these people were men. Of the individuals with personality disorders, 23% struggled with cannabis dependence, 37% abused different types of opioids, and 31% used any type of amphetamine or stimulant. 

When looking at specific drugs, men and women who deal with borderline personality disorder may have a deficiency in opioid activity in their brains. Because of this lack of opioid activity and the symptoms associated, these individuals may seek to use different prescription and illicit opioids at a higher rate than individuals without BPD. 

People with personality disorders may also use stimulants or other drugs as a way to self-medicate. If they struggle with depressive symptoms, feelings of emptiness, impulsivity, or other distressing feelings, they may use drugs as a way to “correct” them. Stimulants may help to increase feelings of euphoria, alcohol may help them to connect with others in social settings, and marijuana may help to calm their mind. But the interaction of these drugs will only cause the brain to crave more.

Personality Disorder Treatment

Treating Substance Abuse and Co-Occurring Personality Disorders

In many cases, personality disorders are lifelong diagnoses that require constant work in order to maintain any negative symptoms. This includes struggling every day not to use drugs or alcohol as a way to escape or self-medicate. The first step is to seek treatment through a dual diagnosis rehab facility that specializes in addressing your specific form of personality disorder. 

Because drugs and alcohol interact with personality disorders, making the symptoms more intense and harder to overcome, it is critical that these conditions be treated simultaneously. Detoxification may be necessary in order to rid the body of substances in a safe environment. At the same time, clients may be prescribed non-addictive medications that stabilize symptoms of their personality disorder. This may include mood stabilizers, SSRIs, or other prescription medications that are safe to use long-term. Other treatment options often used to address these co-occurring conditions include dialectical behavior therapy, individual counseling, group therapies, and more.

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