Birds of a Feather Flock Together: Concurrent Personality Disorders and Substance Use Disorders

Personality disorders (PDs) and substance use disorders (SUDs) have a long history of being recognized as intimately linked, sharing many common clinical features, and frequently co-occurring in individuals seeking treatment for 1 or the other disorder. Equally important, it has long been recognized that the presence of 1 disorder has a significant and negative impact on the prognosis of the other disorder. Individuals with concurrent PD and SUD typically have worse addiction severity and greater impairment in functioning. Clinicians' inability or reluctance to accurately diagnose PDs in a timely manner in SUD patients may inadvertently have a negative impact on their recovery and clinical prognosis. Individuals with concurrent PD and SUD have been observed to present with greater severity of symptoms, to be more resistant to treatment, and have an increased risk of relapse. Unfortunately, despite the significant prevalence of concurrent PDs and SUDs, there is a scarcity of evidence-based treatment approaches for this population. Ideally, these individuals would be offered highly structured integrative care and evidence-based relapse prevention pharmacotherapy for addictive disorders, as there is very limited effective pharmacotherapy for PDs. This article explores the interface between SUDs and PDs, attempting to highlight the complex interaction of the respective disorders and how this might inform treatment choices, specifically the need for comprehensive approaches for patients suffering from PDs and addiction, a population who tend to be stigmatized and marginalized.