How personality disorders might affect drug rehab and addiction recovery

Cluster B personality disorders (e.g., borderline personality disorder) and substance use disorders (SUD) are both marked by impulsivity and poor behavioral control. Previous studies (e.g., Taylor, 2005) have found evidence that symptoms of cluster B personality disorder and SUD are significantly and positively correlated. Because of accumulating evidence which suggests that personality disorders are prevalent in opioid dependent populations, along with evidence linking cluster B personality disorder characteristics and SUD severity, Murray et. al. hypothesized that opioid dependent patients with cluster B personality characteristics would have elevated methadone dose prescriptions (2008). Such a finding would have immediate implications for the doses of methadone, and possibly other medications, early in drug rehab or addiction treatment.

What are Cluster B personality disorders?

The DSM-IV records 10 personality disorders which are grouped into three clusters. Cluster A, odd or eccentric disorders, includes paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder. Cluster C, anxious or fearful disorders, includes avoidant personality disorder, dependent personality disorder, and obsessive-compulsive personality disorder. Cluster B, dramatic, emotional or erratic disorders, includes antisocial personality disorder, borderline personality disorder, histrionic personality disorder, and narcissistic personality disorder.

Antisocial personality disorder, according to the DSM-IV, is marked by “a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood.” Borderline personality disorder typically involves unstable moods as well as unstable interpersonal relationships, behavior, identity, and sense of self. The DSM-IV describes histrionic personality disorder as “pervasive attention-seeking behavior including inappropriate sexual seductiveness and shallow or exaggerated emotions,” while narcissistic personality disorder is described as “a pervasive pattern of grandiosity, need for admiration, and lack of empathy.”

Murray et. al. recruited 54 individuals from a methadone maintenance clinic and examined their methadone dose prescriptions. Results showed that participants with cluster B pathology had significantly higher prescribed methadone doses as compared to participants without cluster B pathology. This study suggests that personality factors appear to influence methadone maintenance.

Certain personality disorders may exacerbate the symptoms of SUD. The co-occurrence of SUD and cluster B traits may be attributed, in part, to shared underlying traits such as impulsivity, poor control of behavior, and negative emotionality. In the future, an examination of such personality traits might help clinicians decide upon a course of treatment during drug recovery. Personality factors might indicate the medications and therapeutic approaches that are most likely to succeed for the individual.

Although it is not yet a common practice in addiction treatment, it would appear sensible to assume that the client in treatment, especially the client in drug rehab, has multiple problems, not just addiction problems. For successful addiction recovery to occur, treatment needs to consider the entire person, not just the addictive behavior.

References

Murray H, McHugh RK, Behar E, Pratt E, Otto M. Personality factors associated with methadone maintenance dose. American Journal of Drug and Alcohol Abuse. 2008; (34)5: 634-641.
 
Taylor, J. Substance use disorders and cluster B personality disorders : Physiological, cognitive, and environmental correlates in a college sample. American Journal of Drug and Alcohol Abuse. 2005; 31(3): 515-535.