Personality disorders and alcohol use disorders often occur together. Research suggests that over a third of people with a personality disorder also struggle with alcoholism. There appear to be multiple reasons for this frequent problem.
Personality Disorders
A personality disorder is a pattern of internal experiences and behaviors that markedly differ from cultural expectations. Common symptoms across many types include unstable self-image, impulsive behavior, extreme emotions, difficulty thinking from others’ perspectives, and stormy personal relationships. Those with personality disorders have rigid ways of thinking and relating that hamper functioning and cause distress.
There are distinct categories like antisocial (disregard for others), avoidant (extreme social inhibition), borderline (chaotic moods and behavior), narcissistic (extreme self-centeredness), dependent (reliance on others for needs), and paranoid (intense mistrust). Treatment in Sonoma County is crucial because personality disorders often accompany depression, eating disorders, anxiety, and substance issues. Early, persistent intervention helps improve one’s quality of life.
How Alcoholics Help Individuals with Personality Disorders Cope
Those with personality disorders may use alcohol to cope with feelings of emptiness, loneliness, self-loathing, anxiety, and other distressing emotions. Self-medicating with alcohol provides temporary relief and escape. Unfortunately, over time alcohol causes brain changes that reduce impulse control, worsen emotion regulation abilities, and make constructive coping even more difficult. This can fuel a vicious cycle of alcohol misuse driven by the need to numb painful inner experiences.
Identity Issues
Personality disorders often involve distorted self-image and lack of identity. Narcissistic individuals may use alcohol to fill inner emptiness and regulate their inflated yet fragile self-esteem. Those with borderline personality struggle with a fragile sense of self, using alcohol to ease chronic feelings of loneliness, anger, and abandonment. The false confidence and momentary escape provided by alcohol offer relief from a nebulous identity and stormy emotions.
Childhood Trauma and Insecure Attachment
Early childhood trauma and insecure attachment are strongly linked to both personality disorders and later alcohol misuse. Trauma imprints the brain in ways that make individuals vulnerable to risky, self-destructive behaviors like heavy drinking later in life. Alcohol may become a coping mechanism to avoid remembering or feeling the painful impacts of early abuse, neglect, loss of caregivers, or other adverse childhood experiences.
The Role of Genetics
Genetics also likely play a role in the connection between personality pathology and alcohol use disorders. Variants of genes involved in neurotransmitter systems, stress response, and behavioral activation may predispose individuals to both conditions. Environmental factors then potentially trigger the genetic risks into manifesting as personality dysfunction and alcoholism.
Treating Individuals who have a Personality Disorder Along with an Alcohol Use Disorder
Treatment for co-occurring personality and alcohol use disorders can be challenging. Therapy must help clients increase distress tolerance, regulate emotions, establish a stable sense of identity, and meet needs for validation and connection through healthy means rather than alcohol. Recovery support groups can supplement therapy by providing social connections and motivation for change. Certain medications may also be appropriate to reduce alcohol cravings and stabilize mood.
The link between personality disorders and alcohol use disorders is multifaceted. Shared genetic, neural, and temperamental vulnerabilities, along with the use of alcohol to self-medicate painful inner states, often lead to the co-development of both conditions. Treating this co-morbidity requires an integrated approach addressing both underlying personality dysfunction and maladaptive drinking behaviors. With appropriate evidence-based treatment, recovery is possible for those wrestling with this dual diagnosis.