Personality Disorders and Addiction.
- What is a personality trait (‘disorder’)? Which medications treat personality most effectively?
- Often medication fails to treat personality.
- What are your options as a provider if this is the case?
- What would you do for a patient who does not respond to medication?
- Discuss pharmacologic choices for the treatment of addiction.
- Can addiction be treated with medication alone?
- What additional supports do you need as a provider to treat addiction effectively?
Personality Disorders and Addiction
- Personality Disorders
A personality disorder is a psychiatric condition in which there is a pattern of rigid pattern of unhealthy behavior, thought processes, and functioning. Personality disorders are a separate diagnostic category with several conditions in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders or DM-5. Examples include sociopathic personality disorder and narcissistic personality disorder (APA, 2013; Sadock et al., 2015).
The Food and Drug Administration or FDA has not yet approved any pharmacotherapeutic agents for the treatment of personality disorders. However, some of the medications have been found to help with reducing the symptoms characteristic of personality disorders effectively. They include antidepressants, mood stabilizers, and anti-anxiety medications. For instance, the selective serotonin reuptake inhibitor (SSRI) antidepressant sertraline (Zoloft) can be used in borderline personality disorder if there is co-occurring anxiety and/ or depression (Ghaemi, 2019).
Indeed medications often are not effective in managing personality disorders. The remaining options as a provider are therefore psychotherapeutic interventions. It has been shown for instance that cognitive behavioral therapy or CBT is effective in managing personality disorders and reducing symptoms (Capuzzi & Stauffer, 2016; Wheeler, 2020). For this reason, I would recommend CBT to a patient who does not respond to medications.
There are various pharmacological choices for the treatment of addictions. For instance, alcohol use disorder can be treated using medications that include disulfiram, naltrexone, and Suboxone amongst others. Naltrexone is also a medication-assisted treatment (MAT) modality for opioid use disorder (Ghaemi, 2019). Addiction cannot be effectively treated with medications alone. Other additional supportive management are required and include psychotherapy and self-help interventions such as the 12-step approach (Capuzzi & Stauffer, 2016; Wheeler, 2020).
American Psychiatric Association [APA] (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Author.
Capuzzi, D., & Stauffer, M.D. (2016). Foundations of addictions counseling, 3rd ed. Pearson Education Inc.
Ghaemi, S.N. (2019). Clinical psychopharmacology: principles and practice. Oxford University Press.
Sadock, B.J., Sadock, V.A., & Ruiz, P. (2015). Synopsis of psychiatry: Behavioral sciences clinical psychiatry, 11th ed. Wolters Kluwer.
Wheeler, K. (2020). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice, 3rd ed. Springer Publishing Company, LLC.