Many empirical data support the existing connection between Substance use disorder and personality disorders, suggesting that the link between dependence on substances And traits of clinical personality is not at all random: the presence of a dysfunction or a pathology affecting the personality would affect not only on the debut of the dependence on substancesmaking it more likely, but also on its trend, on adherence to any treatment and prognosis (Vaillant, 1983).
Specifically, literature has shown that, in the presence of a Personality disorderthe debut of the dependence on substances It tends to be early and that the antisocial, borderline, histrionic and narcissistic disorder of personality increase the probability of developing a drug addiction (Cohen et al., 2007; Lingiardi & Gazzillo, 2014) with an estimate of prevalence at 75% for borderline patients and 95% for those with anti -atocial personality disorder (Hatzitaskos et al., 1999).
As regards patients with diagnosis of narcissistic personality disorder, incidence estimates vary between 6% (Yates et al., 1989) and 38% (Marsch et al., 1988), with lower values if we consider alcohol dependence on those who use cocaine, heroin and in poly-dependent.
Which psychological mechanisms can explain the association highlighted between Personality disorders And dependence on substances? Some authors have studied the way in which a Personality disorder influences the reasons behind theuse of a substance: Each type of drug, in fact, produces very different effects.
Literature highlighted that patients with Narcissist personality They seek in cocaine the “self-medication” to regular dysphoric or depressed mood states (“self-medicaters”) while people with antisocial personality and impulsive traits (“sensation seekers”) use it in an attempt to produce pleasant and positive emotional states (Gunnarsdòttir et al., 2000; Moeller et al., 2001; Rigliano &; Bignamini, 2009). Khantzian, in a 1997 work, concludes his observations by claiming that, in general, cocaine and psycho-stimulants are used to regulate mood (mania, hypomania and depression), while opiates to reduce psychological suffering associated with negative emotion as anger or sadness.
In line with these studies, Pandsepp and Biven (2012) have studied the evolution of neurocircuits or “emotional systems” that regulate the main aspects of our life, highlighting how their alterations, hyperactivations and inhibitions are at the origin of psychological and psychiatric disorders. In particular, the authors have brought back the dependencies on substances to research/reward systems (“Seeking”) and fear/anxiety (“Panic-Grief”).
Every action or positive motivation, which stimulates an active response, passes through the “Seeking” circuit, which is connected with different instinctive, emotional and cognitive brain areas: it is the system that helps to find ways to live with pleasure and satisfaction. The research system has also been called “pleasure circuit” or “reinforcement system” and is characterized by the action of the “dopamine” neurotransmitter, whose recapration is inhibited by drugs such as cocaine.
The fear system, on the other hand, has as its basis the avoidance of pain and danger. When deactivated by the presence of opioids, the fear system connects to feelings of contentment and peace (to give an example, the “Panic-Grief” system is deactivated when a child exposes himself to contact with the care figure, smell or his voice, but also when taking a amazing substance like heroin or morphine).
On the basis of the literature presented, it is evident that the dependence on substances It is a complex and multi-cousal disorder, deriving from an intertwining of biological, cultural and psychological factors, whose manifestation can take place according to different ways and in association with other psychological disorders. A good treatment cannot be separated from an accurate diagnosis: it is appropriate to understand if associated psychopathological conditions exist (for example personality disorders) and how these bind to the dependence on substances.
A good diagnosis must include this information, or at least allow hypotheses to be paid by the evolution of the specific symptom (e.g. use of drugs) in the general context of the person development history. Many rehabilitation paths fail precisely because of the scarce consideration lent to the aspects of co-existence of other psychological/psychiatric disorders or clinical conditions!
The failure of a rehabilitation path is always an event to avoid a person’s life, as not only weakens the hope of healing but often also strengthens negative beliefs compared to itself and with respect to the possibilities of recovery.
Bibliographic references
- Vaillant, Ge (1983). The Natural History of Alcoholism. Harvard University Press.
- Cohen, M., Levin, SH, Gagin, R. & Friedman, G. (2007). Elder Abuse: Ladness Bethaeen Old People’s Disclosure of Abuse, Evasing Signs of Abuse, and High Risk of Abuse. Journal of American Geriatric Society55, 8, pp. 1124-1230.
- Hatzitaskos, P., Soldatos, CR, Kokkevi, A. & Stefanis, CS (1999). Substance Abuse Patterns and Their Association With Psychopathology and Type of Hostility in Male Patient Wit Borderline and Antisocial Personality Disorder. Comprehensive Psychiatry40, 4, pp. 278-282.
- Khantzian, EJ (1997). The Self Medication Hypothesis or Substance Abuse Disorder: A reconsideration and recent Applications. Harvard Review of Psychiatry4, 5, pp. 231-244.
- Lingiardi, V. & Gazzillo, F. (2014). The personality and its ailments. Raffaello Cortina, Milan.
- Moeller, FG, Dougherty, DM, Barratt, Eg, Schmitz, JM, Swann, AC & Grabowski, J. (2001). The Impact of Impulsivey on Cocaine Use and Retection in Treatment. Journal of Substance Abuse Treatment21, 4, pp. 193-198.
- Pansekk, J. & Biven, L. (2012). Archeology of the mind. NeuroEvolutive origins of human emotions. Tr. It. Raffaello Cortina, Milan (2014).
- Rigliano, P. & Bignamini, E. (2009). Cocaine. Consumption, psychopathology and treatment. Raffaello Cortina, Milan.
- Yates, WR, Fulton, Ai, Gabel, Jm & Brass, CT (1989). Personality Risk Factors for Cocaine Abuse. American Journal of Public Health79, 7, pp. 891-892.
