Personality Disorders & Addiction Treatment in Tennessee
Personality disorders and substance use disorders can become deeply intertwined. Long-standing patterns involving emotions, relationships, self-image, trust, impulsivity, avoidance, or coping may increase vulnerability to alcohol or drug use, while active addiction can intensify behaviors and symptoms that are already difficult to manage.
Someone may use alcohol or drugs to reduce emotional pain, quiet anxiety, feel more comfortable with other people, manage anger, escape feelings of emptiness, or act on impulses without fully considering the consequences. As substance use becomes more established, intoxication, withdrawal, sleep disruption, cravings, relationship conflict, and other consequences can make the underlying clinical picture even harder to understand.
Brooks Healing Center provides integrated treatment for adults experiencing personality-disorder symptoms alongside substance use concerns. Located between Nashville and Chattanooga in Normandy, Tennessee, Brooks can provide substance-use detox and stabilization when appropriate, residential dual-diagnosis treatment, individualized therapy, psychiatric and medication support when clinically appropriate, and continued care through our Partial Hospitalization Program and recovery housing options.
Treatment starts by understanding the person rather than reducing them to a diagnostic label. Substance use, trauma, bipolar disorder, depression, anxiety, psychosis, ADHD, withdrawal, medications, relationship patterns, and personality traits can overlap in ways that require careful assessment over time.
John Ingham
Updated on: October 6, 2026 by John Ingham
Table of Contents
Key Points About Personality Disorders and Addiction
- Personality disorders involve enduring patterns of thinking, feeling, relating, and behaving that cause meaningful distress or impairment. These patterns are generally pervasive across situations rather than limited to one temporary crisis.
- The DSM-5-TR recognizes 10 personality disorders, traditionally organized into Clusters A, B, and C. American Psychiatric Association
- Personality traits are not the same thing as a personality disorder. Someone can be perfectionistic, suspicious, emotionally sensitive, socially avoidant, or impulsive without meeting criteria for a disorder.
- Personality disorders and substance use disorders frequently co-occur. Research consistently finds particularly strong overlap with Borderline and Antisocial Personality Disorders. PubMed Central (PMC)
- Substances can intensify or imitate personality-disorder symptoms without necessarily causing a personality disorder. Intoxication, withdrawal, trauma, mood disorders, psychosis, and other conditions need to be considered during diagnosis.
- Psychotherapy is the primary treatment for personality disorders. Medication may help specific symptoms or co-occurring conditions but does not directly “cure” a personality disorder. National Institute of Mental Health
- Dialectical Behavior Therapy was developed specifically for Borderline Personality Disorder and focuses on emotional regulation, distress tolerance, mindfulness, relationships, and reducing self-destructive behaviors. National Institute of Mental Health
- How Brooks helps: Brooks addresses personality-disorder symptoms and substance use together through integrated dual-diagnosis care, residential structure, individualized therapy, relapse prevention, medication support when appropriate, PHP, supportive housing, sober living, and continuing recovery planning.
Personality Disorders & Dual-Diagnosis Treatment at a Glance
| Treatment Component | What It Addresses | When It May Be Important |
|---|---|---|
| Substance-Use Detox & Stabilization | Withdrawal, intoxication, sleep disruption, medical concerns, psychiatric symptoms, and the effects substances may be having on behavior. | When alcohol, benzodiazepines, opioids, or other substances require structured withdrawal support before the longer-term clinical picture can be evaluated more clearly. |
| Residential Dual-Diagnosis Treatment | Substance use and co-occurring personality-disorder symptoms within a structured 24-hour recovery environment. | When relapse, emotional instability, impulsivity, relationships, substance use, or the recovery environment makes lower-intensity treatment difficult to maintain. |
| Behavioral Therapy | Emotional regulation, interpersonal patterns, coping, impulsivity, avoidance, cravings, distress tolerance, and relapse prevention. | Throughout treatment and continued recovery. |
| Psychiatric & Medication Support | Depression, anxiety, psychotic symptoms, mood instability, sleep, and other treatable co-occurring concerns. | When medication is clinically appropriate as part of the broader treatment plan. |
| Partial Hospitalization Program (PHP) | Intensive daytime treatment with increasing independence outside clinical hours. | Following residential treatment or when substantial clinical structure is still needed. |
| Sober Living | Substance-free housing, routine, accountability, peer support, and increasing independence. | For eligible individuals who benefit from continued recovery structure after more intensive treatment. |
What Are Personality Disorders?
Personality refers to the characteristic ways a person thinks, feels, interprets situations, relates to others, and responds to the world around them. Everyone has personality traits, and people naturally differ in areas such as sociability, emotional sensitivity, confidence, caution, organization, impulsivity, or trust.
A personality disorder involves something more persistent.
The American Psychiatric Association describes personality disorders as long-term patterns of inner experience and behavior that differ significantly from cultural expectations and create problems in important areas of life. These patterns affect at least two areas involving thinking, emotional response, relationships, or impulse control. American Psychiatric Association
Personality-disorder patterns generally:
- Begin by adolescence or early adulthood
- Occur across multiple situations
- Remain relatively persistent over time
- Interfere with relationships, work, self-image, or everyday functioning
- Cause significant distress to the person or people around them
The fact that these patterns can be long-standing does not mean they cannot improve. Personality disorders are treatable, and meaningful changes in symptoms, functioning, relationships, and quality of life can occur with appropriate treatment. National Institute of Mental Health
Personality Traits vs. a Personality Disorder
A personality trait becomes clinically important when it is sufficiently rigid, pervasive, and impairing.
For example:
- Being cautious does not automatically mean someone has Paranoid Personality Disorder.
- Preferring time alone does not mean someone has Schizoid Personality Disorder.
- Wanting things organized does not mean someone has Obsessive-Compulsive Personality Disorder.
- Feeling insecure in relationships does not automatically mean someone has Borderline Personality Disorder.
- Wanting recognition does not automatically mean someone has Narcissistic Personality Disorder.
Diagnosis requires understanding the broader pattern, severity, duration, cultural context, and impact on functioning rather than identifying one trait someone happens to have.
The 10 Personality Disorders: Clusters A, B, and C
The DSM-5-TR retains 10 specific personality-disorder diagnoses grouped into three traditional clusters. American Psychiatric Association
| Cluster | Personality Disorder | General Pattern |
|---|---|---|
| Cluster A — Odd or Eccentric | Paranoid Personality Disorder | Persistent distrust and suspicion of others and a tendency to interpret motives as threatening or harmful. |
| Cluster A — Odd or Eccentric | Schizoid Personality Disorder | Persistent detachment from social relationships and a restricted range of emotional expression. |
| Cluster A — Odd or Eccentric | Schizotypal Personality Disorder | Social and interpersonal difficulties accompanied by unusual beliefs, perceptions, communication, or behavior. |
| Cluster B — Dramatic, Emotional, or Erratic | Antisocial Personality Disorder | Persistent disregard for the rights of others, often involving deceitfulness, impulsivity, irresponsibility, or aggression. |
| Cluster B — Dramatic, Emotional, or Erratic | Borderline Personality Disorder | Instability in relationships, self-image, emotions, and behavior, often accompanied by marked impulsivity and sensitivity to abandonment. |
| Cluster B — Dramatic, Emotional, or Erratic | Histrionic Personality Disorder | Persistent excessive emotionality and a strong need for attention or approval. |
| Cluster B — Dramatic, Emotional, or Erratic | Narcissistic Personality Disorder | Persistent patterns of grandiosity, need for admiration, and difficulties with empathy and relationships. |
| Cluster C — Anxious or Fearful | Avoidant Personality Disorder | Social inhibition, feelings of inadequacy, and heightened sensitivity to criticism or rejection. |
| Cluster C — Anxious or Fearful | Dependent Personality Disorder | Excessive need to be cared for that contributes to submissiveness, difficulty making independent decisions, and fears of separation. |
| Cluster C — Anxious or Fearful | Obsessive-Compulsive Personality Disorder | Persistent preoccupation with order, perfectionism, control, rules, and productivity at the expense of flexibility. |
These categories provide useful clinical language, but real people do not always fit perfectly into one box. Someone can have traits associated with multiple personality disorders, and the American Psychiatric Association notes that a person can meet criteria for more than one personality-disorder diagnosis. American Psychiatric Association
Cluster A Personality Disorders
Cluster A includes Paranoid, Schizoid, and Schizotypal Personality Disorders.
People with Cluster A conditions may experience substantial interpersonal distance, mistrust, discomfort with relationships, unusual perceptions, or eccentric patterns of thinking and behavior.
Paranoid Personality Disorder
Paranoid Personality Disorder involves a persistent pattern of distrust and suspiciousness.
Someone may:
- Question other people’s motives
- Assume others intend to exploit or deceive them
- Have difficulty confiding in others
- Interpret harmless remarks as threatening
- Hold grudges
- Become highly sensitive to perceived criticism or betrayal
Substance use can complicate this picture because stimulants, cannabis, hallucinogens, withdrawal, and other drugs can also cause paranoia.
The presence of paranoia during intoxication does not automatically mean someone has a personality disorder.
Schizoid Personality Disorder
Schizoid Personality Disorder involves persistent detachment from social relationships and limited outward emotional expression.
Someone may:
- Prefer solitary activities
- Have little desire for close relationships
- Appear emotionally distant
- Show limited response to praise or criticism
- Have few close friends
These traits should not automatically be interpreted as depression, social anxiety, autism, or substance-related withdrawal without a broader assessment.
Schizotypal Personality Disorder
Schizotypal Personality Disorder can involve:
- Intense social discomfort
- Suspiciousness
- Unusual beliefs
- Odd speech
- Eccentric behavior
- Unusual perceptual experiences
It shares some features with the schizophrenia spectrum, but it is not the same diagnosis as schizophrenia. The American Psychiatric Association notes that people with schizotypal personality disorder may have unusual thinking and perceptions but generally do not experience the sustained psychosis characteristic of schizophrenia. American Psychiatric Association
Substance-induced psychosis also needs to be considered when hallucinations, delusions, or significant paranoia occur alongside drug use.
Brooks provides additional information about drug-induced psychosis.
Cluster B Personality Disorders
Cluster B includes Antisocial, Borderline, Histrionic, and Narcissistic Personality Disorders.
These conditions can involve difficulties with emotional regulation, impulse control, self-image, relationships, or reactions to other people.
The overlap with substance use has been studied particularly heavily in Borderline and Antisocial Personality Disorders. PubMed Central (PMC)
Borderline Personality Disorder and Addiction
Borderline Personality Disorder, or BPD, deserves particular attention because substance use, self-harm, emotional dysregulation, unstable relationships, and impulsivity can become closely intertwined.
The National Institute of Mental Health describes Borderline Personality Disorder as involving difficulty regulating emotions that can affect self-image, impulsivity, and relationships. National Institute of Mental Health
Symptoms can include:
- Intense fear of real or perceived abandonment
- Unstable or intense relationships
- Rapid shifts in how another person is viewed
- An unstable sense of identity
- Chronic feelings of emptiness
- Intense anger
- Significant emotional reactivity
- Impulsive or risky behavior
- Dissociation
- Recurrent self-harm
- Suicidal thoughts or behavior
Substance use itself can be one form of impulsive or self-destructive behavior associated with BPD. National Institute of Mental Health
How Common Is Substance Use With Borderline Personality Disorder?
The overlap is substantial.
Older nationally representative NIMH data estimated that 38.2% of adults with Borderline Personality Disorder also had a past-year substance use disorder, although those data were collected in the early 2000s using DSM-IV criteria and should not be presented as a new 2026 prevalence estimate. National Institute of Mental Health
More recent research continues to demonstrate a strong association. A 2026 meta-analysis involving more than 15,000 adults with BPD estimated that approximately 55% had an alcohol use disorder, although estimates varied between studies and populations. PubMed Central (PMC)
The larger clinical point is not one precise percentage. It is that substance use deserves direct assessment when BPD is present.
Why BPD and Substance Use Can Reinforce Each Other
Substances may be used to:
- Reduce emotional intensity
- Escape feelings of emptiness
- Manage rejection or abandonment fears
- Reduce anxiety
- Numb trauma-related distress
- Act on impulsive urges
- Cope with relationship conflict
- Feel temporarily disconnected from painful emotions
The relief is often temporary.
Intoxication and withdrawal may then increase:
- Impulsivity
- Emotional instability
- Relationship conflict
- Shame
- Self-harm risk
- Financial problems
- Suicidal thinking
- Loss of control
This is one reason integrated treatment becomes particularly important.
Borderline Personality Disorder vs. Bipolar Disorder
BPD and bipolar disorder are sometimes confused because both can involve dramatic mood changes and impulsive behavior.
They are not the same disorder.
In BPD, emotional shifts are often strongly connected with relationships, rejection, abandonment, interpersonal stress, or changes in self-image and may occur over hours or days.
Bipolar disorder involves distinct episodes of mania, hypomania, or depression with specific diagnostic features and duration requirements.
The American Psychiatric Association notes that the patterns associated with BPD are persistent across years, while bipolar symptoms occur in distinct episodes. American Psychiatric Association
Brooks provides a separate guide to Bipolar I and Bipolar II disorder explaining mania, hypomania, and bipolar depression in greater detail.
Substance use can complicate both diagnoses, particularly when stimulants, cannabis, alcohol, sedatives, or withdrawal create significant changes in mood or behavior.
Antisocial Personality Disorder and Substance Use
Antisocial Personality Disorder involves a persistent disregard for the rights of others and may include patterns such as:
- Deceitfulness
- Impulsivity
- Aggression
- Reckless behavior
- Irresponsibility
- Repeated violation of social or legal expectations
- Limited remorse following harmful behavior
Substance use can increase impulsivity, aggression, legal problems, financial instability, and risky behavior, but criminal behavior or addiction alone does not establish an Antisocial Personality Disorder diagnosis.
The diagnosis requires a broader developmental and behavioral history.
Research consistently identifies Antisocial Personality Disorder as one of the personality disorders most strongly associated with substance use disorders. PubMed Central (PMC)
Histrionic and Narcissistic Personality Disorders
Histrionic Personality Disorder
Histrionic Personality Disorder involves persistent patterns of excessive emotionality and attention-seeking.
Someone may place significant importance on being noticed, approved of, or emotionally connected with others and may experience substantial distress when they do not receive the reaction they expected.
Substance use can complicate interpersonal patterns and emotional regulation, but treatment should not reduce the diagnosis to stereotypes such as being “dramatic” or wanting attention.
Narcissistic Personality Disorder
Narcissistic Personality Disorder involves persistent patterns involving grandiosity, need for admiration, and difficulties with empathy or interpersonal functioning.
Someone may also be highly sensitive to criticism, rejection, humiliation, or perceived failure despite appearing highly confident.
Alcohol or drug use may become connected with:
- Shame
- Anger
- Rejection
- Status
- Social settings
- Emotional avoidance
- Failure or disappointment
Narcissistic traits alone do not establish Narcissistic Personality Disorder. Diagnosis depends on the broader and persistent impact on functioning and relationships.
Cluster C Personality Disorders
Cluster C includes Avoidant, Dependent, and Obsessive-Compulsive Personality Disorders.
These conditions are often associated with fear, anxiety, interpersonal insecurity, or attempts to maintain control.
Avoidant Personality Disorder and Substance Use
Avoidant Personality Disorder involves persistent social inhibition, feelings of inadequacy, and heightened sensitivity to criticism or rejection.
Someone may deeply want relationships but avoid:
- Social situations
- Dating
- New activities
- Work opportunities
- Speaking in groups
- Situations where criticism is possible
Alcohol or other substances may become a form of social coping.
For example:
“I can’t go to the party unless I drink first.”
or:
“I need something to calm down before talking to people.”
Short-term relief can reinforce substance use while preventing the person from building confidence without it.
Avoidant Personality Disorder can overlap with social anxiety, but they are not automatically the same condition.
Dependent Personality Disorder
Dependent Personality Disorder involves an excessive need to be cared for and difficulty functioning independently.
Patterns can include:
- Difficulty making everyday decisions without reassurance
- Relying heavily on others to take responsibility
- Difficulty disagreeing because of fear of losing support
- Trouble initiating tasks independently
- Going to excessive lengths to obtain care or approval
- Feeling helpless when alone
- Quickly seeking another relationship when one ends
Substance use may become intertwined with dependent relationships, including relationships in which both people use drugs or alcohol.
Recovery may therefore involve building greater autonomy, boundaries, decision-making skills, and supportive relationships that do not depend on substance use.
Obsessive-Compulsive Personality Disorder
Obsessive-Compulsive Personality Disorder, or OCPD, involves a persistent preoccupation with:
- Order
- Rules
- Productivity
- Perfectionism
- Control
- Details
- Rigid standards
Perfectionism may become so intense that it interferes with actually completing tasks or delegating responsibility.
OCPD Is Not the Same as OCD
This distinction is extremely important.
Obsessive-Compulsive Disorder (OCD) involves obsessions—unwanted intrusive thoughts—and compulsions performed in response to those thoughts or fears.
Obsessive-Compulsive Personality Disorder instead centers on enduring personality patterns involving perfectionism, order, rigidity, and control.
People with OCD often recognize that their compulsions feel unwanted or unreasonable. People with OCPD may view their standards and methods as appropriate or necessary. Merck Manuals
Someone can also have both disorders.
How Common Are Personality Disorders?
The National Institute of Mental Health currently reports an estimated 9.1% past-year prevalence of any personality disorder among U.S. adults, including approximately 1.4% for Borderline Personality Disorder. National Institute of Mental Health
Those estimates come from the National Comorbidity Survey Replication conducted during 2001–2003 and used DSM-IV methods. They remain the national prevalence figures currently published by NIMH but should not be described as newly collected 2026 statistics. National Institute of Mental Health
The same dataset found substantial overlap with other psychiatric conditions. Among adults with any personality disorder, 22.6% also had a past-year substance use disorder, while the estimate was 38.2% among those with Borderline Personality Disorder. National Institute of Mental Health
More recent research continues to describe co-occurring personality disorders and substance use disorders as common and clinically important. PubMed Central (PMC)
Drug Addiction and Personality Disorders
The relationship between addiction and personality disorders is complex and often reciprocal.
People with personality disorders may use substances to cope with:
- Emotional pain
- Anxiety
- Anger
- Shame
- Rejection
- Loneliness
- Feelings of emptiness
- Interpersonal conflict
- Trauma-related distress
- Difficulty regulating impulses
Drugs or alcohol can provide temporary relief or emotional change.
The longer-term consequences can include:
- Withdrawal
- Cravings
- Greater impulsivity
- Emotional instability
- Relationship problems
- Financial stress
- Legal problems
- Sleep disruption
- Isolation
- Shame
- Reduced treatment engagement
A 2023 review found that personality disorders and substance use disorders frequently co-occur and that the combination is associated with greater severity, chronicity, negative consequences, and poorer treatment outcomes compared with either condition by itself. PubMed Central (PMC)
That does not mean a personality disorder inevitably causes addiction or that addiction inevitably causes a personality disorder.
Can Drug or Alcohol Use Cause a Personality Disorder?
Long-term substance use can alter mood, behavior, relationships, judgment, impulse control, and how someone interacts with other people. A person actively using stimulants, alcohol, cannabis, opioids, or other drugs may display behavior that looks dramatically different from their baseline personality.
That does not automatically mean substance use created a personality disorder.
A personality-disorder diagnosis involves an enduring pattern that typically begins by adolescence or early adulthood and persists across situations. Clinicians therefore need to consider whether behavior is better explained by:
- Intoxication
- Withdrawal
- A mood episode
- Trauma
- Psychosis
- Anxiety
- Depression
- Another mental disorder
- Medication effects
- A medical condition
- Acute stress
Research suggests that substance use and personality traits can influence one another over time, particularly around traits involving impulsivity, but the relationship is more nuanced than simply saying drugs “cause” a personality disorder. PubMed
Why Personality Disorders Can Be Difficult to Diagnose During Active Addiction
Diagnosing a personality disorder during active addiction can be challenging because substance use can temporarily alter many of the same areas clinicians are trying to evaluate.
For example:
Stimulants may produce:
- Suspiciousness
- Grandiosity
- Irritability
- Impulsivity
- Aggression
- Psychosis
Alcohol may contribute to:
- Disinhibition
- Anger
- Relationship conflict
- Recklessness
- Depression
Cannabis may contribute to:
- Social withdrawal
- Anxiety
- Paranoia
- Motivation changes
Sedatives may affect:
- Judgment
- Emotional expression
- Impulse control
- Relationships
A period of stabilization can therefore help clinicians observe which patterns persist after acute intoxication and withdrawal resolve.
Assessment may also consider:
- Childhood and adolescent history
- Long-term relationship patterns
- Self-image
- Impulse control
- Previous psychiatric treatment
- Trauma
- Family history
- Behavior during periods of sobriety
- Legal and occupational history
- Previous mood episodes
Personality Disorders, Trauma, and Addiction
Trauma and personality disorders can overlap, but the relationship needs careful wording.
Experiencing childhood adversity, unstable relationships, abuse, neglect, or trauma may increase vulnerability to certain personality disorders, particularly Borderline Personality Disorder, but trauma does not automatically cause a personality disorder.
Likewise, not everyone with a personality disorder has a trauma history.
When trauma is relevant, Trauma-Informed Therapy can help treatment account for those experiences without assuming that every current behavior is simply a trauma response.
Trauma treatment should also be timed and individualized according to psychiatric stability, substance use, safety, and readiness.
Treatment for Personality Disorders and Addiction in Tennessee
When a personality disorder and substance use disorder occur together, treating only one can leave major drivers of the other problem unaddressed.
SAMHSA recommends integrated treatment for people with co-occurring mental health and substance use disorders, and its guidance specifically notes that treatment for people with personality disorders and SUDs should address both conditions rather than neglecting one. SAMHSA
Integrated treatment may address:
- Withdrawal
- Cravings
- Emotional regulation
- Impulsivity
- Avoidance
- Relationship patterns
- Anger
- Shame
- Self-image
- Trauma when relevant
- Depression
- Anxiety
- Self-harm risk
- Relapse patterns
- Healthy boundaries
- Recovery environment
Medical Detox and Stabilization
If physical dependence on alcohol, benzodiazepines, opioids, or another substance is present, treatment may begin with medical detox and stabilization.
Detox does not treat a personality disorder.
It can create a period of greater medical and psychiatric stability during which clinicians can monitor:
- Withdrawal
- Mood
- Behavior
- Sleep
- Impulsivity
- Psychotic symptoms
- Current medications
- Suicide or self-harm risk
- Changes as intoxication resolves
That period can also make the longer-term diagnostic picture clearer.
Residential Dual-Diagnosis Treatment
Following stabilization, clinically appropriate patients may continue into residential treatment at Brooks.
Residential structure can be especially useful when personality-disorder symptoms and addiction have disrupted:
- Relationships
- Daily routine
- Treatment attendance
- Ability to remain abstinent
- Emotional regulation
- Housing
- Medication adherence
- Boundaries
- Recovery support
A structured environment also creates repeated opportunities to practice new relationship and coping skills in real interactions rather than discussing them only in theory.
Therapy for Personality Disorders and Addiction
Psychotherapy is the primary treatment for personality disorders. Medication may be useful for certain symptoms or additional diagnoses, but there is no single medication that directly treats the enduring personality pattern itself. National Institute of Mental Health
The specific psychotherapy should depend on the diagnosis, treatment goals, substance use, safety concerns, and what modalities are clinically available.
Dialectical Behavior Therapy
Dialectical Behavior Therapy is particularly important when discussing Borderline Personality Disorder.
DBT was specifically developed for BPD and teaches skills involving:
- Mindfulness
- Emotional regulation
- Distress tolerance
- Interpersonal effectiveness
The National Institute of Mental Health identifies DBT as an established psychotherapy for Borderline Personality Disorder, including helping people regulate intense emotions, reduce self-destructive behaviors, and improve relationships. National Institute of Mental Health
Those same skill areas can also be highly relevant when substance use has become an impulsive response to intense emotion.
Cognitive Behavioral Therapy
Cognitive Behavioral Therapy helps patients identify relationships among beliefs, thoughts, emotions, and behaviors.
CBT may help someone examine:
- Beliefs about themselves
- Beliefs about other people
- Automatic interpretations of rejection
- Substance-use triggers
- Avoidance
- Impulsive reactions
- Relationship patterns
- Relapse thinking
NIMH also identifies CBT as one psychotherapy that may help people with BPD modify inaccurate beliefs and behaviors and improve interactions with others. National Institute of Mental Health
Experiential Therapy
Experiential Therapy can provide structured opportunities to work on:
- Emotional awareness
- Relationships
- Trust
- Communication
- Coping
- Boundaries
- Self-awareness
This can complement talk therapy by giving patients opportunities to notice interpersonal and emotional patterns in real time.
Trauma-Informed Therapy
Trauma-Informed Therapy can be incorporated when trauma is relevant to the individual treatment plan.
The goal is not to label every personality disorder as trauma-driven. It is to ensure that treatment recognizes the possible impact of trauma while maintaining appropriate boundaries, safety, and clinical structure.
Brainspotting
Brainspotting Therapy may be incorporated when clinically appropriate, particularly when trauma or difficult emotional experiences are part of the broader treatment picture.
It should be viewed as one possible component of individualized treatment rather than a stand-alone treatment for a personality disorder.
12-Step Recovery Support
12-Step Recovery Support can provide community, accountability, peer connection, and continued recovery structure alongside clinical treatment for substance use.
Are Medications Used for Personality Disorders?
There is no medication that directly treats a personality disorder in the way an antibiotic treats an infection.
Psychotherapy remains the central treatment.
Medications may still be clinically useful when someone also experiences:
- Major depression
- Anxiety
- Mood symptoms
- Severe irritability
- Psychotic symptoms
- Sleep problems
- ADHD
- Another psychiatric disorder
For Borderline Personality Disorder specifically, NIMH notes that the benefits of medication are unclear and medication is not considered first-line treatment for BPD. A clinician may use medication to treat specific symptoms or co-occurring conditions rather than the entire personality disorder itself. National Institute of Mental Health
This distinction also helps avoid unnecessary polypharmacy when the most important intervention is sustained psychotherapy and behavioral change.
Emotional Regulation, Impulsivity, and Substance Use
Two themes often connecting personality disorders and addiction are emotional regulation and impulsivity.
Someone may experience an intense emotion and rapidly move from:
Feeling rejected → drinking
Feeling empty → using opioids
Feeling angry → using cocaine
Feeling anxious → taking sedatives
The substance changes the emotional state quickly.
That immediate relief reinforces the behavior.
Treatment can help create space between emotion and action so the person can:
- Identify the feeling
- Recognize the urge
- Tolerate distress
- Consider consequences
- Use another coping skill
- Communicate more effectively
- Seek support
- Allow the emotion to change without using a substance
This is especially relevant to BPD but can also matter across other personality patterns and substance use disorders.
Relationships, Boundaries, and Addiction Recovery
Relationships can become one of the most important treatment areas when personality symptoms and addiction occur together.
Patterns may include:
- Fear of abandonment
- Difficulty trusting
- Unstable relationships
- Conflict
- Dependency
- Isolation
- Difficulty setting boundaries
- Difficulty respecting boundaries
- Reassurance seeking
- Idealizing and then devaluing another person
- Remaining in relationships centered on substance use
Substance use can temporarily soften interpersonal distress while creating even more relationship damage over time.
Treatment can help patients practice:
- Clear communication
- Healthy boundaries
- Conflict resolution
- Tolerating rejection
- Recognizing unhealthy relationship patterns
- Asking for help appropriately
- Maintaining recovery relationships
Personality Disorders and Self-Harm or Suicide Risk
Certain personality disorders—particularly Borderline Personality Disorder—can be associated with increased risk of self-harm and suicidal thoughts or behavior.
NIMH specifically notes that people with BPD experience substantially higher rates of self-harm and suicidal thoughts and behavior. National Institute of Mental Health
Substance intoxication can increase this risk further by reducing inhibition and worsening impulsivity.
Immediate help is needed when someone:
- Has suicidal intent
- Has a suicide plan
- Has recently attempted suicide
- Is engaging in medically dangerous self-harm
- Cannot remain safe
- Is severely intoxicated and suicidal
- Becomes psychotic or dangerously disorganized
- Is threatening serious harm to themselves or someone else
For an immediate life-threatening emergency, call 911.
For suicidal thoughts or a mental-health crisis in the United States, call or text 988.
Continuing Care After Residential Treatment
Personality-disorder symptoms often involve long-standing interpersonal and behavioral patterns, so treatment generally extends beyond one residential stay.
Continued care may include:
- Individual psychotherapy
- Psychiatric follow-up
- Medication management when appropriate
- DBT or other structured skills work
- Substance-use treatment
- Peer recovery support
- Family education
- Relapse-prevention planning
- Healthy relationship development
- Housing and routine
- Continued safety planning
Partial Hospitalization Program
Brooks’ Partial Hospitalization Program provides intensive daytime treatment for medically stable patients who continue to need substantial clinical structure after residential care.
PHP can include therapy, psychiatric or medication follow-up when appropriate, recovery education, relapse prevention, emotional-regulation work, and continued support for co-occurring symptoms.
Eligible patients who need structured housing while participating in PHP may use supportive housing in Tullahoma.
Sober Living
For eligible individuals who no longer require intensive clinical care but continue to benefit from accountability and a substance-free environment, Brooks provides sober living in Tullahoma.
This can provide additional time to practice boundaries, communication, routine, recovery skills, and independence while returning to work, relationships, finances, and community life.
Why Choose Brooks for Personality Disorders and Addiction Treatment in Tennessee?
Brooks Healing Center provides integrated treatment for substance use and co-occurring personality-disorder concerns between Nashville and Chattanooga in Normandy, Tennessee.
Treatment does not assume that every difficult behavior comes from addiction or that every personality trait represents a disorder.
Assessment can consider:
- Long-term personality patterns
- Current alcohol and drug use
- Withdrawal
- Emotional regulation
- Impulsivity
- Relationship history
- Trauma when relevant
- Self-harm
- Suicide risk
- Depression
- Anxiety
- Bipolar symptoms
- Psychotic symptoms
- Medication history
- Previous treatment
- Patterns during periods of sobriety
- Recovery environment
- Relapse history
Brooks is accredited by The Joint Commission and licensed by the Tennessee Department of Mental Health and Substance Abuse Services.
Depending on clinical need, the Brooks continuum can include:
- Medical detox and stabilization
- Residential dual-diagnosis treatment
- Psychiatric and medication support when clinically appropriate
- Individual and group therapy
- Dialectical Behavior Therapy
- Cognitive Behavioral Therapy
- Trauma-Informed Therapy
- Experiential Therapy
- Brainspotting
- 12-Step Recovery Support
- Relapse-prevention planning
- Partial Hospitalization Program
- Supportive PHP housing
- Sober living
- Continuing recovery planning
The strongest value of integrated treatment is the ability to look at personality patterns, substance use, withdrawal, relationships, impulsivity, emotions, and relapse risk together rather than asking the patient to solve them as unrelated problems.
Does Insurance Cover Personality Disorder and Dual-Diagnosis Treatment?
Many commercial health insurance plans include behavioral-health and substance-use benefits, although exact coverage depends on the individual policy, diagnoses, medical necessity, recommended level of care, network status, deductible, coinsurance, and authorization requirements.
Brooks’ admissions team can verify your insurance benefits before admission and explain the information provided by your insurance carrier.
Insurance verification does not guarantee payment, but it can help patients and families understand which benefits may be available.
Get Help for Personality Disorders and Addiction in Tennessee
Personality-disorder symptoms and addiction can reinforce one another through emotional distress, impulsive behavior, difficult relationships, avoidance, shame, and repeated substance use.
Neither condition has to be solved before the other deserves attention.
Effective dual-diagnosis treatment looks at how substance use interacts with emotions, relationships, self-image, behavior, trauma when relevant, withdrawal, and relapse risk instead of reducing the person to a diagnosis.
Brooks Healing Center provides integrated care for adults with co-occurring personality-disorder symptoms and substance use through stabilization when appropriate, residential treatment, individualized therapy, psychiatric and medication support when clinically appropriate, PHP, supportive housing, sober living, and continued recovery planning.
Call Brooks Healing Center at 931-486-8824 to speak with admissions.
Frequently Asked Questions About Personality Disorders and Addiction
Can Personality Disorders Cause Substance Abuse?
Personality disorders do not directly or inevitably cause substance use disorders.
Certain symptoms—such as impulsivity, emotional distress, interpersonal conflict, social avoidance, or difficulty coping—can increase vulnerability to using alcohol or drugs.
Substance use can then reinforce or worsen some of those same problems.
Can Drug Use Cause a Personality Disorder?
Drug use can significantly change behavior, emotions, judgment, relationships, and impulse control, but that does not automatically mean it creates a personality disorder.
Personality disorders generally involve patterns beginning by adolescence or early adulthood that persist across situations.
Clinicians need to distinguish enduring patterns from changes caused by intoxication, withdrawal, mood episodes, psychosis, trauma, or other conditions.
What Is the Most Common Personality Disorder?
Prevalence varies by population, diagnostic method, and the specific personality disorder being studied.
NIMH’s national survey estimate found that approximately 9.1% of U.S. adults had any personality disorder, while Borderline Personality Disorder was estimated at approximately 1.4%. Those data were collected during 2001–2003 and should not be interpreted as a new 2026 survey. National Institute of Mental Health
What Are the Three Clusters of Personality Disorders?
The traditional DSM-5-TR clusters are:
Cluster A: Paranoid, Schizoid, and Schizotypal Personality Disorders.
Cluster B: Antisocial, Borderline, Histrionic, and Narcissistic Personality Disorders.
Cluster C: Avoidant, Dependent, and Obsessive-Compulsive Personality Disorders. American Psychiatric Association
Is Borderline Personality Disorder the Same as Bipolar Disorder?
No.
Borderline Personality Disorder involves long-standing patterns involving emotional regulation, relationships, self-image, and impulsivity.
Bipolar disorder involves distinct mood episodes such as mania, hypomania, and major depression.
The two can co-occur and can share some features, but they are different diagnoses.
Is OCPD the Same as OCD?
No.
OCD involves intrusive unwanted obsessions and compulsive behaviors or rituals.
OCPD involves enduring personality patterns centered on perfectionism, order, rigidity, productivity, and control.
People can have one condition, both conditions, or neither. Merck Manuals
Is Borderline Personality Disorder Treatable?
Yes.
Evidence-based psychotherapy can help people with BPD reduce symptom severity, improve relationships and functioning, and improve quality of life.
DBT was developed specifically for Borderline Personality Disorder and focuses on emotional regulation, distress tolerance, mindfulness, and interpersonal skills. National Institute of Mental Health
What Therapy Is Best for Personality Disorders?
There is no single therapy that is best for every personality disorder.
Psychotherapy is the primary treatment, but the approach depends on the diagnosis, symptoms, treatment goals, risk, and clinician expertise.
DBT has especially strong relevance to Borderline Personality Disorder, while CBT and other structured psychotherapies may be useful for different patterns and symptoms.
Are Medications Used to Treat Personality Disorders?
Medications may help specific symptoms or co-occurring disorders such as depression, anxiety, mood symptoms, or psychosis.
They generally do not directly treat the underlying personality disorder itself.
For Borderline Personality Disorder, psychotherapy is considered the primary treatment and medication is not first-line treatment for the disorder as a whole. National Institute of Mental Health
What Are Common Signs of Substance Abuse in Someone With a Personality Disorder?
Signs can include:
- Increasing secrecy
- Intoxication
- Withdrawal
- Cravings
- Missing responsibilities
- Relationship deterioration
- Financial problems
- Increasing impulsivity
- Risk-taking
- Repeated unsuccessful attempts to stop
- Escalating conflict
- Using substances to manage emotions or relationships
Substance use may intensify existing symptoms, but clinicians should avoid automatically assuming every behavioral change is caused by the personality disorder.
Can Treatment for Addiction Work if Someone Has a Personality Disorder?
Yes.
Personality disorders can make some aspects of treatment more complex, but they do not make recovery impossible.
Integrated treatment that addresses both substance use and mental-health needs is generally preferable to ignoring one condition. SAMHSA recommends integrated care for co-occurring disorders. SAMHSA
Can Brooks Treat Borderline Personality Disorder and Addiction Together?
Brooks provides integrated dual-diagnosis treatment for clinically appropriate adults experiencing personality-disorder symptoms alongside substance use concerns.
Treatment can address substance-use stabilization, emotional regulation, impulsivity, relationships, coping, relapse prevention, co-occurring depression or anxiety, and continuing-care needs within a coordinated plan.
Does Brooks Provide Residential Treatment for Personality Disorders and Addiction?
For clinically appropriate adults experiencing personality-disorder concerns alongside substance use, Brooks provides residential dual-diagnosis treatment between Nashville and Chattanooga in Normandy, Tennessee.
The appropriate level of care depends on substance use, psychiatric stability, self-harm or safety risk, medical needs, previous treatment, current functioning, and the recovery environment.
How Long Does Treatment for a Personality Disorder Take?
There is no universal timeline.
Personality patterns often develop over years, so meaningful change typically requires continued treatment beyond a short residential stay.
Residential care can begin stabilization and intensive skill development, while longer-term outpatient psychotherapy, psychiatric care, peer support, and continuing recovery services may remain important after discharge.
Sources
American Psychiatric Association. (2024, November). What are personality disorders? https://www.psychiatry.org/patients-families/personality-disorders/what-are-personality-disorders
Juchem, C. M., Bendau, A., Bandurski, L. C., Reich, N. J., Baumgardt, S., & Asselmann, E. (2024). Personality changes related to presence and treatment of substance use (disorders): A systematic review. Psychological Medicine, 54(9), 1905–1929. https://pubmed.ncbi.nlm.nih.gov/38644674/
National Institute of Mental Health. (n.d.). Personality disorders. Retrieved October 6, 2026, from https://www.nimh.nih.gov/health/statistics/personality-disorders
National Institute of Mental Health. (2025). Borderline personality disorder. https://www.nimh.nih.gov/health/publications/borderline-personality-disorder
Silva, S. G., Pedro, M. O. P., & Castaldelli-Maia, J. M. (2026). Prevalence of alcohol use disorders in individuals with borderline personality disorder: A meta-analysis and meta-regression study. São Paulo Medical Journal, 144(1), Article e2024480. https://pmc.ncbi.nlm.nih.gov/articles/PMC12885496/
Stetsiv, K., McNamara, I. A., Nance, M., & Carpenter, R. W. (2023). The co-occurrence of personality disorders and substance use disorders. Current Psychiatry Reports, 25(11), 545–554. https://pmc.ncbi.nlm.nih.gov/articles/PMC10798162/
Substance Abuse and Mental Health Services Administration. (n.d.). Co-occurring disorders and other health conditions. https://www.samhsa.gov/substance-use/treatment/co-occurring-disorders
Substance Abuse and Mental Health Services Administration. (2020). Substance use disorder treatment for people with co-occurring disorders (Treatment Improvement Protocol [TIP] Series 42; Publication No. PEP20-02-01-004). https://library.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP20-02-01-004.pdf
Substance Abuse and Mental Health Services Administration. (2025, September 26). Screening and treatment of co-occurring disorders. https://www.samhsa.gov/mental-health/serious-mental-illness/co-occurring-disorders
Zimmerman, M. (2026, January). Obsessive-compulsive personality disorder. Merck Manual Consumer Version. https://www.merckmanuals.com/home/mental-health-disorders/personality-disorders/obsessive-compulsive-personality-disorder