It is not confined just to combat veterans, but is found as well in people who have suffered abuse or have been victims of crime, severe accidents, or natural disasters. Stopping the use of the alcohol or drugs means that the symptoms and painful feelings must be dealt with in another way. If the problems are ignored, relapse is a potential problem.

Another class of psychological problems that tends to promote addiction is the personality disorders. A personality disorder is a mode of reacting to life’s stresses that is usually fixed in place by problems that occurred early in a person’s life. It’s a stable pattern of maladjustment. People with personality disorders are “one-tool carpenters.” They have a limited range of responses to problems and often find themselves in conflict with other people or with the world.

Those with personality disorders frequently lack insight into their own behavior, tending to see their problems as being caused by their situation or by someone else. As a result, they have a hard time making lasting adaptations to new situations. Such people find it difficult to carry out the changes necessary to recover from addiction, but many can do so over time.

Borderline personality disorder is believed to arise from a combination of genetic and environmental factors. Most people with borderline personality disorder were severely abused, often sexually, as children. The abused child develops an early fixation that provides a way for him or her to cope unconsciously with overwhelming anxiety. The fixation is useful for that purpose, but it severely cripples a person in the development of mature relationships, the handling of stress and conflict, and the creation of a consistent personal identity. Alcohol or drug abuse of an on-again, off-again nature is common in people with this disorder, and some go on to become addicted.

Antisocial personality disorder also appears to have roots in childhood development, but there is evidence that vulnerability to this disorder is passed along in families as well.

In fact, a link may exist between Type II alcoholism and antisocial personality, and there also seems to be some overlap with attention deficit disorder. People with antisocial personality disorder are deficient in their ability to relate to other people in a mutual fashion, seeming to be able to relate only to the extent that others meet their immediate needs. They also have difficulty with conduct, ethics, and mores. They judge their own actions by utility (“Is this going to get me what I want?”) rather than by morality (“Is this the right thing to do?”). They also seem to have difficulty learning from painful experience, which puts them at tremendous risk for addiction since they are unlikely to avoid a mood-altering substance that gives immediate gratification even if they have had a bad experience with it in the past.

Attention deficit disorder is commonly known as hyperactivity. It is diagnosed in children, but follow-up studies have shown that as many as 40 percent of people diagnosed with the disorder do not outgrow the problem. Those with attention deficit disorder have difficulty sustaining a train of thought for as long as is necessary to complete a task. Children with the disorder have trouble in school, are impulsive, and appear immature. We used to believe that hyperactivity was usually present, but now we know that a substantial number of children have a type of attention deficit disorder characterized by inattention. These children do not behave the way hyperactive kids do, but they have the same problems with sustaining attention.

Adults who had attention deficit disorder as children have an increased risk of developing alcohol or drug dependence.

They also have a tendency toward underachievement and low self-esteem. Attention deficit disorder is often treated with drugs from the amphetamine family. Sometimes a person with unrecognized or untreated attention deficit disorder will discover that the stimulants available on the street are effective in reversing the symptoms of impaired attention, and this begins a process that often leads to addiction. Nicotine also seems to have a beneficial effect, and it’s thought that many hard-core smokers are actually people with this disorder who find it difficult to function without cigarettes and therefore have a hard time quitting.

Biologically based brain disorders include major depression, panic and anxiety disorders, schizophrenia, and bipolar disorder (manic-depression). We know that all of the biologically based brain disorders increase the risk that a person will develop addiction. Having one of these disorders is a powerful host factor in the risk for addiction. Mood-altering drugs are often fairly effective at first in managing the symptoms of these disorders, which are painful and disruptive.

The concept of an “addictive personality” has been quite popular. According to this idea, there are people who, because of their personalities, engage in excessive behavior with a given drug or activity. There is no scientific basis for this assumption. As we have seen, there appears to be an inherited risk for addiction that runs in families, but it only accounts for about half the risk, and does not correlate with any particular personality characteristics.

The remaining proportion of risk can be attributed to a wide variety of disorders, as well as to social and cultural factors. However, the concept of an “addictive personality” just won’t die despite reams of research. I have worked with a lot of people with addiction, and my hunch is that this concept lives on because it provides some with a ready excuse for continuing addictive behaviors and not taking responsibility for recovery, which is difficult to do.

Elizabeth Connell Henderson, M.D.

Glossary

Appendix A: Regulation of Addictive Substances

Appendix B: Sources of Additional Information