Dual Diagnosis Treatment: Treating The Addicted
Obsessive-Compulsive 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). For individuals with OCPD,
addictive or
compulsive behavior may be an attempt to manipulate internal discomfort and negative feelings while continuing to adhere to rigid patterns of coping with external reality.
Drug and alcohol
use can be a means to manage the impact of tension and physiological strain on individuals with OCPD in the course of their usual day.
Individuals with OCPD may have some protection against drug/alcohol addiction because of the potential for loss of control involved in intoxication, dependence, and withdrawal. They are also disinclined to engage in the illegal and high risk behaviors involved in the use of street drugs. On the other hand, compulsive behaviors can become severely disruptive and exert harsh negative consequences. Almost by definition, these individuals are vulnerable to work addiction. Compulsive behaviors related to money and sexual behaviors are also common, e.g., compulsive hoarding, bargain-seeking, compulsive use of
phone sex, etc.
Drugs of Choice for the Obsessive-Compulsive Personality Disorder
Milkman & Sunderwirth (1987, p. xiv) propose that the drug of choice for anyone is actually a pharmacologic defense mechanism; it is chosen by how well it fits with individuals' usual style of coping and how effectively it bolsters already established patterns for managing psychological threat. Richards (1993, p. 257) suggests that individuals with OCPD will respond positively to the relief afforded by drugs to their overloaded (and conflicted) psychological and physiological being. Drugs and alcohol can easily become an accelerating addiction for these individuals as they acquire ingrained habits with little effort. The function of OCPD addiction is usually escape/avoidance or modulation of painful affect. The drug of choice is primarily alcohol or a prescribed medication because these substances do not involve the risks intrinsic to illegal drug use.
Individuals with OCPD may be attracted to drugs that enhance work performance. They may seek CNS stimulants to increase their stamina and capacity for sustained productivity. While they may joke about excessive use of caffeine, they may well be attracted to stronger stimulants, such as amphetamines, in times of stress or when caffeine is not powerful enough to give them the boost they believe they need.
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Reviewed: 04/2006
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