Paranoid Personality Disorder (PPD) And Addiction

Medically Reviewed by Johnelle Smith, M.D on April 19, 2021

People with paranoid personality disorder (PPD) demonstrate continuous, unfounded paranoia and general mistrust. Treatment for co-occurring substance use disorder and paranoid personality disorder can be difficult because people with PPD often resist professional intervention.

Medically Reviewed by
Johnelle Smith, M.D on April 19, 2021
Dual Diagnosis Paranoid Personality Disorder And Addiction

Paranoid personality disorder results in generally paranoid thought and behavior patterns that make it difficult to relate to and interact with other people.

Some people with PPD engage in drug or alcohol use as a way to cope with their reality.

Co-occurring personality disorders and substance use is common across the United States. People with PPD tend to resist treatment for substance use disorders because of their inherent distrust for others.

Still, therapeutic and pharmaceutical interventions can be useful when a person with PPD seeks help at an inpatient or outpatient detox/rehabilitation facility.

Read more about dual diagnosis personality disorders and addiction

What Is Paranoid Personality Disorder?

Paranoid personality disorder (PPD) is a “cluster A” personality disorder that is marked by eccentric behavior or thinking.

People with PPD are typically distrustful of others to the point of paranoia without a good reason. They often have difficulty functioning in society and don’t recognize that their behavior is abnormal.

There are no medications that can treat symptoms of PPD. Therapy can be helpful, but people with PPD are often resistant to treatment because they often do not recognize their condition.

Symptoms of paranoid personality disorder may include:

  • constant suspicion of others
  • constant mistrust of others and their motives
  • the belief that others are trying to harm or deceive (without evidence)
  • suspicion regarding others’ loyalty or trustworthiness (without evidence)
  • inability to confide in others due to an unreasonable fear that others will use the information against you
  • perception of statements, glances, or other non-threatening behavior as a personal attack or insult
  • anger or hostile reactions to these perceived attacks
  • increased likelihood of holding grudges
  • unfounded suspicion of infidelity in a partner or spouse

Signs Of Drug Or Alcohol Abuse

People with PPD may engage in substance use to escape from constant fears or paranoia.

Some people with PPD take substances like opioids, benzodiazepines, or alcohol to depress the central nervous system and alleviate feelings of anxiety, anger, or obsession.

A cycle of substance use can worsen symptoms of PPD, which makes it more difficult for a person to recognize how addiction is impacting their life.

Signs of drug or alcohol abuse may include:

  • withdrawing from family or friends
  • mood swings
  • sudden behavioral changes
  • being unable to stop or control substance use
  • taking uncharacteristic risks
  • neglecting personal hygiene or health
  • using drugs or alcohol daily to function
  • being evasive about substance use

Some symptoms of PPD may overlap with signs of drug or alcohol use.

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Also, some substances including alcohol, cocaine, methamphetamine, hallucinogens, and marijuana can increase feelings of paranoia.

What Causes Co-Occurring Addiction And Paranoid Personality Disorder?

People with personality disorders are generally more predisposed to substance use.

Social, developmental, and biological factors may impact a person with PPD to have a substance use disorder.

Brain Differences

One study suggests the possibility that people with some personality disorders have differences in the prefrontal cortex region of the brain that regulate impulsivity.

The brain’s lowered ability to regulate impulsivity can be substantially impacted by the increase of dopamine that happens when some substances are used.

Family Mental Health History

PPD is more common in people who have close relatives with schizophrenia and delusional disorder suggests a genetic link between the two disorders (may run in the family).

It is also believed that early childhood experiences, including physical or emotional trauma, play a role in the development of PPD.

Self-Medication And Coping

Because people with PPD are often viewed as “difficult” to be around, they may resort to drugs or alcohol to escape or self-medicate.

This form of stress relief or social relief can both worsen symptoms of PPD and cause additional symptoms related to symptoms of addiction and dependence.

Shared risk factors for paranoid personality disorder and substance abuse include:

  • family history of addiction and personality disorder
  • co-morbid mental health issues like anxiety or depression
  • difficult family life or early trauma

How Common Is Substance Abuse And Paranoid Personality Disorder?

PPD is among the most common personality disorders in the United States. Personality disorders generally correlate to substance use, although causes cannot be definitely determined.

Paranoid Personality Disorder and addiction statistics:

  • Between 2% to 4.4% of the United States population are thought to have PPD.
  • PPD is thought to occur more commonly in men and in families with a history of PPD.
  • One study of people with alcohol use disorder listed PPD as the third-most prevalent personality disorder (10%).

What Are The Most Effective Treatments?

While there are no medications to alleviate symptoms of PPD, some people with a dual diagnosis can benefit from therapy.

Medication can also help address symptoms of withdrawal stemming from substance detox.

Dual diagnosis treatment may involve:

  • Cognitive-Behavioral Therapy
    • Encourages awareness of paranoia and negative thought patterns
    • Encourages revisiting scenarios with a different perception of intentions
    • Encourages self-control regarding thought patterns, feelings, and responses
  • Dialectical Behavior Therapy
    • Encourages balance and emotional and social awareness in group settings
    • Teaches mindfulness (observing emotions without reacting to them)
    • Encourages techniques to control reactions to paranoid thoughts
  • Medications therapy:
    • benzodiazepines, buprenorphine, naltrexone, and methadone

Finding Dual Diagnosis Treatment For Addiction And Paranoid Personality Disorder

For people with dual diagnosis PPD and addiction, the biggest hurdle is usually entering treatment.

A combination of in-person therapy in conjunction with medically assisted detox and rehabilitation programs can help people with PPD move forward without substance use.

Call our treatment specialists for help finding a dual diagnosis rehab center near you or your loved one.

Our range of inpatient and outpatient facilities can provide the best environment for any set of co-occurring conditions.

Get in touch today to get started.

This page does not provide medical advice. See more

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