Chapter 8
Drugs and Personality Disorders.
We all think we know what a "personality" is. It is all the characteristic ways a person behaves and thinks. Someone may be shy, very dramatic, or may be very sensitive. We tend to categorize people as behaving in one way in many different situations. For example, many of us are shy with people we do not know, but we will not be shy around our friends. A truly shy person is shy even among people he or she has known for some time; the shyness is part of the way the person behaves in most situations, it is an enduring and consistent way of behaving. We usually consider a way of behaving part of a person's personality only if it occurs in many times and places. What if a person's way of thinking and behaving causes significant distress to the self or others? What if the person cannot change this way of relating to the world and is unhappy? We might consider this person to have a "personality disorder". A person with a personality disorder has personality characteristics that are inflexible and maladaptive and cause significant distress and impairment. Personality disorders are also chronic; they do not come and go but originate in childhood and continue throughout adulthood. Because they affect personality, these chronic problems spread throughout every aspect of a person's life. If a man is overly suspicious, for example (a sign of a possible paranoid personality disorder), this trait will affect almost everything he does. This includes employment (he may have to change jobs frequently if he believes his co-workers conspire against him), his relationships (he may not be able to sustain a lasting relationship if he cannot trust anyone), and even where he lives (he may have to move if he thinks his neighbours are out to get him). Although having this disorder may distress the affected person, individuals with personality disorders may not feel any distress; indeed, it may be accurately felt by others because of the actions of the person with the disorder. This is particularly common with antisocial personality disorder, because the individual may show a blatant disregard for the rights of others, yet exhibit no remorse. In certain cases, someone other than the person with the personality disorder must decide whether the disorder is causing significant functional impairment, because the affected person cannot make such a judgement. We should note here that, unfortunately, people who have personality disorders in addition to other psychological problems tend to do poorly in treatment. Data from several studies shows that people who are depressed have a worse outcome in treatment if they also have a personality disorder.
The causes of personality disorders vary from genetics to childhood trauma but there is often a correlation between drug abuse and personality disorders. However, it is also important to examine what came before the other, since in some cases it is the personality disorder that leads to an increase in the abuse of alcohol and other substances. In most scenarios, conditions like borderline and antisocial personality disorders actually increase the risk of alcoholism, especially during teen age and early adulthood. Before making a conclusion on how, if at all, drugs cause personality disorders, it is important to interrogate how these substances affect the brain and how these effects correlate to characteristics associated with various disorders. We examine the relationship between drugs and Personality Disorders in more detail in the next chapter.
Alcohol and most drugs work by altering the rate at which impulses are transmitted from one nerve cell to another. Specialised chemical carriers called neurotransmitters are used to relay the impulses and each neurotransmitter has a specific purpose and effect. Dopamine, one of these chemicals, imparts a sensation of joy or happiness every time we do something that is helpful to the body; for example, a slight increase in dopamine levels is experienced after enjoying a good meal. However, most commonly abused drugs trigger an excessive release of this neurotransmitter, flooding the brain with the feel good sensation. This results in addiction, since, the individual will want to experience the sensation over and over again.
Continuous use of drugs results in tolerance for the neurotransmitter, meaning that more of the substance is required to achieve the same result. In most cases of drug addiction, the user finds it hard to get into a good mood without the use of a certain substance, and at times the result is a sense of withdrawal from social situations. In severe cases, Schizoid or Paranoid tendencies may become noticeable, leading to an alteration in personality. It is also not uncommon for individual in such a state to show signs of aggression, disobedience or indifference. Addiction and mental illness are, however, not synonymous. People with drug addiction often recover after undergoing various rehabilitation processes and at times the effects of drug use are reversed, leading to a complete recovery. In cases of personality disorder, more deep-rooted factors are the cause, and at times, most afflicted persons have to live their whole lives with the disorder. The characteristics of drug addiction quite often resemble those of persons with mental illness and it is at times difficult to distinguish between the two. However, it is important to note that the extended abuse of certain substances can lead to personality disorders, especially when no active steps are taken to resolve the addiction. This is commonly caused by an addiction-induced, irreversible imbalance in brain functionality. In order to establish a definitive confirmation of an existing personality disorder, a series of diagnostic parameters have to be identified and this often happens after the successful treatment for drug addiction. There are several identifiable causes of personality disorders, and these include chemical imbalances in the brain or other neurological factors, genetic inheritance and even dysfunctional early childhood development. It is however, difficult to decisively conclude that drug abuse directly causes personality disorders. However, it is also not prudent to completely rule this out as a cause. Nevertheless, there is solid evidence that indicates an increased risk of drug and substance abuse among individuals with personality disorders. In the case of borderline personality disorder, which is characterised by mood swings, depression and a general sense of introversion, alcoholism and drug addiction is common.
Some studies have shown that about 12% of cocaine and alcohol users display borderline tendencies. Other conditions like antisocial, avoidant and schizoid Personality Disorders have also been associated with increased use of drugs and subsequent addiction. In some situations, the knowledge that one has a personality disorder, drives the individual to use drugs in order to try and raise their spirits. Mostly, it is an intense feeling of loneliness and depression associated with a specific condition, which leads to substance abuse. A major problem arises due to this, since substance abuse, agitates and increases symptoms associated with personality disorder. Feelings of self-loathe increase due to excessive drug use and this may lead to higher chances of the individual inflicting self-harm or even committing suicide. When it comes to treating personality disorders, various therapeutic methods have been used and it is often quite important to also treat the co-existing addiction to alcohol and other substances. The relationship between addiction and personality disorders is incontestable, but the question as to whether or not addiction is a direct cause of personality disorders, is one that requires a more thorough and systematic interrogation by psychologists and other researchers in similar fields of science.
