In the general population of mental health, a lot of clients who share with their practitioner or doctor that they are using a substance may face discharge from their doctor or counsellor. One of the reasons is that it’s very hard to get a bead on what the problem is when you add substance use or addictive disorder into the mix.
Addictive disorders and substance use can be very destabilizing, I’ve mentioned in earlier posts that you can take a healthy individual and make them quite mentally and physically out of shape just by applying large amounts of alcohol. One particular study was one of students given more than 50 units of alcohol (50 unis = 10ml ethanol per unit, 500ml of ethanol) over a weekly period for a period of 12 weeks showed noticeable increase of depression (Gill, Jan S. 2002). This depression, caused by alcohol consumption, lingered for 6 weeks after abstinence from alcohol.
50 units of alcohol is about a bottle and a third of vodka for a week. Which isn’t actually that high at all for those who have a alcohol/substance use disorder.
Emotional instability can be incredibly masking of what the core issues are for a person. This is why those without experience of drugs and alcohol patients will often discharge or refer their patients onwards.
Substance use disorder can share a lot of traits with personality disorders, in particular, anti-social personality, narcissism and sometimes borderline behaviour.
Just because you share traits with a disorder does not mean you have the disorder, they may be more pronounced because of other destabilizing factors around you, sometimes the substance themselves or sometimes because of the circumstances you’ve found yourself in.
For example:
Mr Jones has been out drinking very heavily, his wife doesn’t like his drinking she knows it’s destroying him. Mr Jones knows this but he has never explored any means of coping around his substance use. As far as Mr Jones’ experience tells him, he drinks because he is very depressed and anxious, so instead of telling his wife about this aspect of his drinking, he decides to go drinking immediately afterwork and tells his wife that he is tied up with work and cannot come home.
One way of looking at the above is that Mr Jones is lying to his wife, and of course he is. However, Mr Jones is adapting to his situation, maybe if it weren’t for the alcohol he wouldn’t need to lie? Lying and manipulating are traits of anti-social personality disorder, potentially even psychopathy, but is Mr Jones a manipulator or is he just trying to adapt to deal with a problem?
Substance Use Disorders (SUD) create problems for patients in multiple ways within their lives, SUD’s effect the way a person behaves and the way in which they can function within society (ASAM, 2011). Some of the behaviour of a substance use disorder patient can share very similar traits to an Antisocial Personality Disorder. People with Antisocial Personality Disorder are driven to extremes, acquisitive behaviour and failure to learn from mistakes despite consequences to name a few. Many people state that their addiction to substance drove their behaviour to act out in extreme ways, however in this essay the author intends to explore the relationship between which came first.
Chicken or the Egg?
Data from the UK shows us that drug offences roughly make up 15% of the prison population (Gov.uk 2020), however these are directly related to crimes that involve the sale, transportation and possession of drugs. Drugs are also linked to violent behaviour for certain individuals, alcohol is the most common drug linked to violent crimes (Makkai and Payne 2003). As well as being strongly linked to violent behaviour they are also linked to burglaries to acquire funding for habitual addiction (Blevins et al, 2016). One has to question do these psychoactive substances and addiction to them promote more Anti-social behaviour? Or is it that antisocial personality types are drawn more towards drugs?
Drug use in populations of antisocial patients are much higher than average. Cannabis and cocaine are the two main drugs of choice of those testing positive for anti-social personality disorder (Aggen et al, 2018). Most of those whom will present in treatment will do so from difficulties arising from their anti-social personality disorder (ASPD) and also substance use disorder. Those with ASPD will more than likely meet most the requirements for substance use disorder (APA DSM-5, 2013).
Drug use and engagement of a drug “lifestyle” is recognized as a big part of ASPD persons thinking styles (Walters 2006). This drug use alone can sometimes introduce people to criminal behaviour as most drugs of choice for ASPD are illegal in most countries, which immediately places them on the wrong side of the law and may start a legacy of economic and social deprivation that leads to further criminal actions (Brochu et al, 2018).
At some point in a person’s life they may come forward for treatment for their Substance Use Disorder, but if so many traits of an SUD is shared with a ASPD how do we detect the differences?
The Dark Triad
Within forensic psychology there is a measurement tool known as the Dark Triad to measure levels of Narcissism, Machiavellianism and Psychopathy. It is a simple tool that allows psychologists and other professionals to produce a snap-shot of how high these levels are within their patient. Narcissism is notably higher than general populations in those who are seeking treatment for alcoholism at 12 Step peer-to-peer meetings (Hagler et al, 2013).
Although the Dark Triad measures psychopathy, narcissism and Machiavellianism, these only share traits with ASPD. One of the most notable aspects of difference between ASPD and psychopathy is that psychopathy presents with a distinct lack of anxiety, low levels of withdrawal and high amounts of attention seeking (Caretti 2014). Not all ASPD is bad, nor does it always require treatment. Some aspects of ASPD can evoke great personal gain or corporate legacy, however “positive” results are rarer (Ohira and Osumi 2010).
In the 1950’s a recovery movement known as Narcotics Anonymous began to create a book of anecdotes of recovery, a lot of the personal stories in this book point towards anti-social behaviour that is not normally associated with the psychoactive effects of drugs.
“On more than one occasion, gun battles broke out. What we then called fun, we now call insanity.
Today, our notion of fun has changed. Fun to us today is a walk along the ocean, watching the dolphins frolic as the sun sets behind them. Fun is going to an NA picnic, or attending the comedy show at an NA convention. Fun is getting dressed up to go to the banquet and not worrying about any gun battles breaking out over who did what to whom.” – (Basic Text, p107)
Narcotics Anonymous is a recovery movement chiefly concerned with heroin addiction. The psychoactive effects of heroin are one of mainly sedation and euphoria. It alone is very unlikely going to make someone pick up arms and go into a gun battle. However, the social decline and personal emotional turbulence the drug can cause in people’s lives may resort to such actions (Parks 2015).
Although it is highly likely that someone with ASPD will develop a SUD, they can often lack some of the traits of addictive disorders (ASAM, 2011, APA DSM-5 2013). A person with ASPD may find giving up substances easier than someone who has an addictive disorder. When a person gives up drugs or attempts to change their habits they can sometimes become overwhelmed with specific cravings for that drug (ASAM, 2011). However, in the case of ASPD persons they may not experience any cravings for the drug at all if they give up within a controlled environment (Duggan et al, 2010).
Psychoactive substances can make a person much more impulsive, so with continued usage or relapse a person may never resolve issues they face with ASPD. If they have previously been an offender they are likely to slip back into offending behaviour. Therefore if a person is to treat their ASPD they should take recovery from drugs seriously (Abelfatah and Gaber 2016).
In summary the relationship between ASPD and SUD is very clear, one certainly affects the other but not all people with a substance use disorder will have an ASPD despite a lot of similarities between the two. Recovery from both is certainly possible and treatment methods do overlap which means in effect the two may be treated simultaneously. Part of the recovery model for some peer-to-peer groups focus on overcoming selfishness (a large part of ASPD) some traits of ASPD However may not treat it directly, or indeed recognize it properly (Hagler et al, 2013).
Refences:
Abelfatah, M.E., Gaber, O.H., (2016) Relationship between Personality Disorders and Relapses among Sample of Substance Abuse Patients. Journal Of Psychology & Clinical Psychiatry Published: November 18, 2016. Available at: https://medcraveonline.com/JPCPY/relationship-between-personality-disorders-and-relapses-among-sample-of-substance-abuse-patients.html
Aggen S.H., Czajkowski N., Gillespie N.A., Knudsen, Neale N., R. Nesvåg, E. Ystrom, K.S. Kendler, T. Reichborn-Kjennerud , S.C. South, (2018) Associations between personality disorders and cannabis use and cannabis use disorder: a population-based twin study. Addiction Journal. Pp1488-1498 Available at: https://experts.umn.edu/en/publications/associations-between-personality-disorders-and-cannabis-use-and-c
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
ASAM (2011) The Definition of Addiction. Accessed 1st October 2020 from https://www.asam.org/resources/publications/magazine/public-policy-statements/2011/12/15/the-definition-of-addiction
Blevins K.R., Bolin R.M., Cambareri J.F. and Kuhns J.B. (2016) Drug Use and Abuse as Primary Motivators for Involvement in Burglary: A Comparison of Self-Reported Differences Among a Random Sample of Male and Female Burglars. Journal of Drug Issues, Available at: https://journals.sagepub.com/doi/10.1177/0022042616678613
Brochu S., Brunelle, N., and Plourde, C. (2018) Drugs and Crime – A Complex Relationship. 3rd Edition. Published By University of Ottawa Press, Canada.
Caretti V., Craparo G., Giannnini M., Gori A., Meringolo P., Sareri I.G., (2014) Antisocial and psychopathic personalities in a sample of addicted subjects: Differences in psychological resources, symptoms, alexithymia and impulsivity. Comprehensive Psychiatry. Available at : https://www.researchgate.net/publication/262107127_Antisocial_and_psychopathic_personalities_in_a_sample_of_addicted_subjects_Differences_in_psychological_resources_symptoms_alexithymia_and_impulsivity
Duggan, C., Ferriter, M., Huband, N., Khalifa, N., Lieb, K., and Stoffers, J. (2010) Pharmacological interventions for antisocial personality disorder. PMC. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4160654/
Hagler K. Tonigan JS, Rynes K andToscova R, (2013) Do changes in selfishness explain 12-step benefit? A prospective lagged analysis. Subst Abus. 2013;34(1):13-9. doi: 10.1080/08897077.2012.691453. PMID: 23327500; PMCID: PMC5588914. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5588914/
Gill, Jan S. (2002) REPORTED LEVELS OF ALCOHOL CONSUMPTION AND BINGE DRINKING WITHIN THE UK UNDERGRADUATE STUDENT POPULATION OVER THE LAST 25 YEARS. Alcohol and Alcoholism : International Journal of the Medical Council on Alcoholism; Oxford Vol. 37, Iss. 2, (Mar 2002): 109.
Gov.uk (2020) Prisons data https://data.justice.gov.uk/prisons
Makkai, T., and Payne, J. (2003) Drugs and Crime: A Study of Incarcerated Male Offenders. Australian Institute of Criminology, Research and Public Policy Series no. 52. Available at: http://www.aic.gov.au/media_library/publications/rpp/52/rpp052.pdf
Narcotics Anonymous (1980) The Basic Text, 6th Edition.
Ohira, H., and Osumi, T. (2010) The positive side of psychopathy: Emotional detachment in psychopathy and rational decision-making in the ultimatum game.
Parks P. (2015) Heroin Addiction. Published by Refence Point Press, San Diego, CA, USA pp21 – pp35
Walters, G. (2006) The Lifestyle Approach to Substance Abuse and Crime. Antisocial Personality Disorder – A Practitioners’ Guide. Ed Maniacci, M., and Rotgers, F. Published By Springer Publishing Company, New York USA. Pp91- 113
Dylan Kerr Addiction Therapy 