Avoidant Personality Disorder

 

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Dual Diagnosis Treatment:
Treating The Addicted Avoidant Personality Disorder


Cluster C: Incidence of Co-Occurring Substance Abuse Disorders 

Cluster C has a high incidence of co-occurring substance
abuse disorders, though not as high as Cluster B
(Nace, O'Connell, ed., 1990, p. 184). 

Individuals with personality disorders, due to their
frequent failures in self-regulation, have an increased
inclination to use drugs and alcohol as alternative 
solutions to life problems. This failure in self-regulation 
and faulty adaptation to normal stressors can usually be
 attributed to deficiencies or disturbances in the personality 
(Richards, 1993, pp. 227-240). As Freud has said, intoxicating 
substances keep misery at a distance and provide a greatly 
desired degree of independence from the external world. 
With the help of drugs, anyone can withdraw from the 
pressures of reality and find refuge in a world of their 
own (Khantzian, Halliday, & McAuliffe, 1990, Opening page). 
Individuals with AvPD are lonely, sad, and unable to find 
comfort either within themselves or with others. They are 
extraordinarily vulnerable to the seductivity of drugs 
and alcohol for solace, courage, and avoidance of pain. 
Addiction may be quite advanced with significant negative 
consequences in place before individuals with AvPD can begin 
to consider that they must give up the one reliable source 
of self-comfort they have in their lives. 

While Khantzian, et. al. (1990, p. 3) view the treatment 
of any character disorder as the road to recovery from 
addiction, their approach also demands a continued attention 
to and concern about maintaining abstinence and avoiding 
relapse. Addiction becomes a disorder in its own right 
and must be addressed directly. However, the treatment 
of personality disorders can lead to profound change 
in the personality disordered individuals' experience 
of self and the world, which, in turn, can positively 
affect recovery from addiction. 

Drugs of Choice for the Avoidant Personality Disorder.


For individuals with AvPD, drugs and alcohol provide 
escape/avoidance of painful feelings and the situations 
that elicit these feelings. Drug use assists in modulating 
hyperarousal and self-deprecatory thoughts. Some 
individuals with AvPD prefer mild hallucinogens over 
other drugs, perhaps because they facilitate fantasy. 
However, sedatives and antianxiety agents are usually the 
drugs of choice for most clients with AvPD 
(Richards, 1993, p. 269). While sedative-hypnotics
calm anxiety, stimulants or PCP can provide a sense 
of strength or reduced vulnerability. The drug of 
choice for these individuals will be whatever gives 
them a sense of efficacy or allows them to believe 
that they can be attractive and effective interpersonally. 

Many individuals with AvPD also develop compulsive 
behaviors that relate to appearance enhancement, 
fantasy, and self-comfort. They may enter treatment 
with compulsive shopping, compulsive sexual behaviors, 
and eating disorders in place as well as with drug or 
alcohol addiction. Abstinence, to be effective, will 
need to address all self-destructive behaviors as 
well as drug and alcohol use. 

Dual Diagnosis Treatment for the Avoidant Personality Disorder. 

Dual diagnosis treatment for individuals with AvPD 
must consider the function of their addiction, 
including their drug of choice, within the context 
of their personality psychopathology 
(Richards, 1993, p. 278). While these 
individuals may admit drug abuse, they 
will be inclined to refuse to acknowledge 
the reality or the meaning of their 
addiction (Richards, 1993, pp. 238-239). 
They gain some sense of control with their 
addictive behavior, despite negative consequences. 
The key that opened the doorway to excess for 
preaddicted individuals with AvPD was the good 
feeling that they learned to create, and 
repeatedly recreate, through self-determined 
drug-using activity (Milkman & Sunderwirth, 1987, p. 16). 
They have learned to feel happy by manipulating feeling 
states rather than by coping with external 
reality (Hoskins, 1989, p. 37). Or alternatively, 
they may be attempting to cope with external 
reality with chemical courage or drug-induced 
self-confidence. Either way, these individuals 
are modifying their troubled feelings without 
influencing their causes. Their addiction is a 
magical solution to the pain of life 
(Peele, 1985, p. 120). As such, they will 
be quite resistant to the loss of their drug of choice. 

Salzman (Mule, ed., 1981, pp. 346-347) believes 
that the inner forces that initiate and sustain 
addiction are immaturity, escapism, and grandiosity. 
New ways must be learned for dealing with feelings 
of powerlessness and helplessness other than 
compulsivity. A nonaddicted lifestyle includes an 
awareness that negative feelings, insoluble problems, 
and a sense of inadequate rewards will never disappear 
entirely. To move beyond addiction, individuals must 
be willing to tolerate the uncertainty of life and 
must believe they have the strength to generate 
positive rewards for themselves (Peele, 1985, p. 156). 

Dual diagnosis group treatment can address 
both the addiction issues and allow the 
corrective action of a positive group 
experience to take place for individuals 
with AvPD. Peers can confront unrealistic 
expectations, normalize many painful feelings 
by sharing their own, and give support for 
behavioral change. 

The impact of the 12 Step Groups may be 
powerful enough to allow individuals with 
AvPD to seek their strength through the 
recovery community rather than through 
addiction. However, successful integration 
into the 12 Step recovery process may require 
support and encouragement from treatment 
providers to assist with whatever initial 
negative experiences may occur and to counteract 
the inclination these individuals have to 
withdraw from and avoid anxiety-inducing 
interpersonal experiences. 

Confrontation usual to substance abuse 
treatment may defeat these individuals 
and overwhelm their defenses. Individuals 
with AvPD already know how to give up in 
defeat and humiliation cannot be tolerated. 
Confrontation should be modified and more 
supportive than needed for individuals 
with greater self-confidence. 

Abstinence should not be a prerequisite 
to treatment. Individuals with AvPD 
believe they can do very little and are 
inclined to define themselves as incapable 
of accomplishing their goals. Because they 
are inclined to give up, abstinence as a goal 
can allow service providers to bolster 
self-confidence for clients with AvPD through 
manageable treatment objectives. Small increments 
of change can assist these individuals to 
believe that they can achieve abstinence as a 
long-term goal. 

Table of Contents 

Sharon C. Ekleberry, 2000 




 

 

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