Alcohol Addiction and Personality Disorders

Personality disorders (PDs) are types of mental health disorders characterized by long-term disruptive patterns that affect people’s thoughts, feelings, and behaviors.¹ Personality disorders and alcohol use disorders (AUDs) commonly co-occur, in which case a person is said to have a co-occurring disorder, also known as dual diagnosis.²

Many PDs co-occur with alcohol use disorder, but borderline personality disorder (BPD) and antisocial personality disorder (ASPD) are both associated with increased risk of alcohol misuse and AUDs.³ Research suggests that integrated dual diagnosis treatment using components from multiple therapies can lead to positive health outcomes for people with AUD and PDs.³ Understanding what personality disorders are, how they can manifest alongside alcohol addiction, and how find effective dual diagnosis treatment can help you start your journey to recovery.

What Are Personality Disorders?

According to the American Psychiatric Association (APA), people with PDs display thoughts, feelings, and behaviors that deviate from the expectations of the culture, cause distress or problems functioning, and are long-lasting.¹ PDs usually begin in adolescence or early adulthood and typically cause significant impact on a person’s life and the lives of those around them.¹

PDs affect a person’s thinking, emotions, relationships, and behaviors in different ways depending on the type of PD.¹ However, they all involve maladaptive and extreme changes in normal personality traits.⁴

Qualified mental health clinicians use diagnostic criteria from the DSM-5 to diagnose someone with a personality disorder; only people aged 18 and older can receive a PD diagnosis.¹ A professional will conduct a thorough interview and evaluate a person’s symptoms to determine whether the person meets criteria for a diagnosis.¹

There are 10 distinct PDs that are divided into 3 clusters.⁵

Cluster A includes paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder. Cluster A disorders are characterized by odd or eccentric behaviors.⁵

Cluster B includes antisocial personality disorder, borderline personality disorder, histrionic personality, and narcissistic personality disorder. People with these PDs seem dramatic, emotional, or erratic.⁵

Cluster C includes avoidant personality disorder, dependent personality disorder, and obsessive-compulsive personality disorder. People with these disorders frequently seem anxious or fearful.⁵

While you may know people who fit into these categories, there is a fine line between a personality disorder and personality “quirks”. A PD affects a person’s ability to function and detrimentally affects their mental well-being.⁵ People with a PD experience common symptoms, such as problems in:

• The way they think about themselves and others.¹
• The ways they emotionally respond.¹
• The ways they relate to others.¹
• The ways they control their behaviors.¹

Each PD has different diagnostic criteria, but may share some common symptoms. For example, people with BPD or ASPD often display impulsive behaviors and negative emotions, but these two disorders are then also characterized by specific traits.^{1, 3}

The Relationship Between Personality Disorders & Alcohol Misuse

Personality disorders and alcohol use disorders are common co-occurring mental health disorders.³ Different studies have shown different prevalence rates of co-occurring PDs and AUDs, with ranges from 22-40% to as high as 58-78%.²

Cluster B personality disorders, which involve negative emotions, disinhibition, and antagonistic behaviors, are some of the most common PDs to occur along with alcoholism.^{3, 4}

AUD is the clinical diagnosis for alcoholism or alcohol addiction.⁶ It is a medical disease that occurs when a person is unable to stop or control their alcohol use despite the negative social, occupational, or health consequences.⁶

Researchers offer different potential reasons for the common co-occurrence of PDs, specifically Cluster B PDs, and AUD, including:

• Both Cluster B personality disorders and AUD often involve overlapping traits, including high levels of impulsivity, negative emotions, low conscientiousness, and antagonism.^{3, 4}
• Developmental considerations can play a role in the development of alcoholism and personality disorders; for example, studies have shown people who display traits associated with PDs such as impulsivity or neuroticism in adolescence and early adulthood may be more likely to develop problems with alcohol.³
• People who already have PDs often develop problems that can provoke AUD, such as interpersonal or occupational problems.³
• Brain adaptations that occur due to excessive and chronic alcohol consumption over time could cause increased impulsivity or negative emotionality associated with PDs.³
• People with PDs may enter high-risk environments that could trigger AUD.³
• People with PDs may drink to cope with negative emotions or symptoms of stress, anxiety, fear, or feelings of depression, and drink to enhance positive emotions.^{2, 3}

Borderline Personality Disorder & Alcohol Misuse

Borderline personality disorder (BPD) and AUD commonly co-occur. One study found that people with a lifetime BPD diagnosis have a lifetime prevalence rate of 50.7% for SUDs (including AUDs), while another study found that 14.3% of people with AUD were diagnosed with BPD.⁷ Another study showed a 59% comorbidity rate of personality disorders and SUDs and determined that people who had a lifetime AUD and/or SUD had a significant predisposition to a BPD diagnosis.⁷

As mentioned above, there are often common traits that occur among people with BPD and alcohol use disorder. Characteristic features that are often associated with both disorders include mood reactivity, emotional instability, impulsivity, dysregulation, previous history of trauma, suicidality, identity disturbance, and difficulties in interpersonal relationships.^{3, 7}

Antisocial Personality Disorder & Alcohol Misuse

Antisocial personality disorder (ASPD) involves symptoms such as repeated criminal acts, deceitfulness, impulsivity, repeated fights or assaults, a lack of regard for others’ safety, irresponsible behavior, and a lack of remorse.⁸ Impulse control, antisocial behaviors, conduct disorders, and hyperactivity in childhood and adolescence are strongly associated with future problems with alcohol.²

Some research indicates that impulsivity and low conscientiousness are linked to both ASPD and AUD.⁴ Research has also shown that people with antisocial personality disorder start drinking earlier, have a more rapid and serious course of illness, and display more negative problems because of drinking.²

As with other studies of AUD and PDs, prevalence rates for AUD and ASPD vary depending on the specific study, but recent research is limited. One study found that 28.6% of individuals with a current AUD diagnosis had at least one personality disorder, and vice versa, and also found that the prevalence of antisocial personality disorder was 12.3% in people with AUD. ² Another study found that the prevalence of AUD among people who were diagnosed with ASPD was about 68%.³

Narcissistic Personality Disorders and Alcohol Misuse

Although research is still ongoing, other personality disorders like narcissistic personality disorder may also appear alongside AUD. For example, research in college students found that certain features of NPD, such as grandiosity and insecurity, were positively associated with co-occurring narcissistic personality disorder and AUD.⁹

A study of alcohol misuse and narcissism and other personality disorders found that the prevalence of lifetime narcissistic personality disorder among people with any lifetime alcohol use was 9.1%, and the prevalence of schizotypal personality disorder was 8.4%.²

Dual Diagnosis Treatment for Personality Disorders & Alcohol Addiction

Integrated (or concurrent) dual diagnosis treatment may promote positive treatment outcomes in those struggling with alcohol addiction and co-occurring mental health disorders like personality disorders. Concurrent treatment for both disorders can not only help people start the path to recovery from AUD but also teach necessary skills to manage PDs, such as emotional regulation skills.^{4, 10}

In some cases, people may first undergo detox to safely withdraw from alcohol, before progressing to further treatment.³ Detox can help address potentially severe withdrawal symptoms such as seizures while keeping people as safe and comfortable as possible.¹¹ It can help them become medically stable so they can continue to ongoing treatment.

Treatment for AUD and BPD may include a combination of medication, psychotherapy, and behavioral therapies.¹² In particular, people may receive specialized forms of cognitive-behavioral therapies, such as dialectical behavior therapy (DBT), Dynamic Deconstructive Psychotherapy, or Dual Focus Schema Therapy to teach healthier coping skills and address maladaptive personality traits and behaviors.^{3, 12}

Treatment for AUD and ASPD may also include medication, psychotherapy, or behavioral therapies such as contingency management, which involves providing tangible rewards when people meet target behavioral goals, or DBT.³ There are, however, limited studies that have evaluated the specific types of therapies that may benefit people with co-occurring ASPD and AUD.³

Finding Treatment for Personality Disorders & Alcohol Addiction

If you or a loved one are struggling with co-occurring personality disorders and alcohol misuse or AUD, you should know that help is available. You might first consult your doctor to discuss a possible diagnosis and inquire about referrals to rehabs in your area. You can also use the Substance Abuse and Mental Health Services Administration’s online Behavioral Health Treatment Services Locator to search for facilities.

Addiction helplines, like the one owned and operated by American Addiction Centers, are also beneficial resources to help people seeking treatment. Our admissions navigators can answer questions you may have about PDs and AUDs, help you understand the treatment process, and connect you with rehab centers that may be appropriate for your or your loved one’s unique needs. Don’t delay, call us now at to learn more about treatment opportunities.