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Concurrent Disorders: Personality Disorder

Hope Rehab Dual Diagnosis Depression

Personality disorders are very common in those seeking help with addictive behaviours. Antisocial Personality DisorderBorderline Personality Disorder and Narcissistic Personality Disorder are the most frequently associated with substance abuse. For example, there are estimates that approximately 80 % of individuals with an Antisocial Personality Disorder and 60-70 % of individuals with Borderline Personality Disorder will end up abusing illegal substances, and/or display other forms of addictive behaviours.

Please Note: Hope successfully treats many clients with common mental health issues such as depression and anxiety, usually together with addiction. However Hope Rehab is not a substitute for a psychiatric unit and do not have a psychiatrist onsite. We know our program is ideal for clients suffering with many types of mental health issues. We work closely with the Doctors/Psychiatrists at the hospital opposite who provide all our detox and medication needs. All clients must undergo a formal psychological assessment with our team and need to be able to function safely in our community. The reason we are selective is to protect all clients from unnecessary disappointment and disruption. If you are in any doubt please double check with our admissions department.

The Dangers of Self-Medicating When Suffering With A Personality Disorder

People who are dealing with a personality disorder can be tempted to turn to alcohol or drugs in an attempt to soothe their inner discomfort. This act of self-medication can feel like it is working in the beginning, but it is actually making the situation worse. The person can then end up in a catch-22 situation where it is not possible to effectively treat the personality disorder because of the substance abuse, and it is not possible to effectively treat the substance abuse because of the personality disorder.

What are Personality Disorders?

Personality Disorders can be defined as enduring patterns of thinking and behaving that deviate significantly from standard cultural norms, and these patterns typically cause significant impairment in all areas of functioning. Individuals with personality disorders usually display strongly inflexible and rigid ways of thinking, perceiving and responding to the world around them. They also tend to be unable to adapt to changing contexts or circumstances, and they are very much resistant to change.

Personality disorders are associated with ways of thinking and feeling about oneself and others that significantly and adversely affect how an individual functions in many aspects of life.

– American Psychiatric Association (Personality_Disorders_Factsheet.pdf)

Are there different types of Personality Disorders?

In short, yes. The Diagnostic Statistical Manual (DSM-V) lists currently ten different types of personality disorder, and as mentioned above, three of those are most commonly associated with serious substance abuse problems:

Antisocial Personality Disorder:

Individuals with this diagnosis display a profound and consistent disregard for societal rules or social norms, based on the belief that rules somehow don’t apply to them. Individuals with this personality disorder tend to be overrepresented in the criminal justice system, as they typically do not hesitate to violate the rights and property of others.

Borderline Personality Disorder (BPD):

More commonly diagnosed in women, this disorder is characterized by pronounced difficulties regulating one’s emotions, a poor self-image and a tendency to instigate drama and crisis in interpersonal relationships and occupational settings alike. Individuals suffering from BPD may resort to self-harm, and they have a tendency to resort to suicidal ideation or suicidal gestures as a way of coping with distress.

Narcissistic Personality Disorder:

Individuals with this disorder display a strong sense of grandiosity, a need for admiration. They tend to feel superior towards others and are likely to dominate interpersonal interactions.

All 10 Types of Personality Disorder

It is possible to divide personality disorders into three clusters

The exact symptoms a person experiences depends on the type of personality disorder, but they can include:

Why are Personality Disorders so Difficult to Treat in Rehab Settings?

Individuals with comorbid personality and substance use disorders pose significant conundrums to addictions rehab centers as they:

What Treatment does Hope Rehab Center Offer for Personality Disordered Clients?

It is important to remember that personality difficulties exist on a continuum, ranging from adaptive/useful ways of being in the world on one end of the continuum, to maladaptive/unhelpful ways of being in the world on the other end of the continuum. Most of us, substance dependent or not, display at least some behaviours on the maladaptive and unhelpful end of the spectrum when we are in distress, and when things are not going well for us.

While we do not offer specialized long-term treatment for specific personality disorders at Hope Rehab Center, we carefully assess in which life areas and to what degree individuals struggle. Based on this assessment, our skilled team members tailor individual therapy sessions to address these specific needs and challenges and to improve overall functioning. Furthermore, Hope Rehab Center offers proven interventions to address addictive behaviours, anxiety and depression, all of which typically accompany personality problems and when treated improve day to day functioning.

Our team has a good track record of helping clients who have been diagnosed with a personality disorder. We provide individualised care to ensure that you have access to the resources you need to transform your life. You will be warmly welcomed into our therapeutic community, and you will be entering an environment where amazing transformations happen on an almost daily basis.

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Hope Medication Policy

Note: Please bring your doctor’s contact details with you so you and the Hope team can seek appropriate advice if necessary.

Prescribed Medications: Any long-term medications from your Doctor, are best to bring in a plentiful supply to cover you for up to 2 months minimum. Most clients extend longer than a month. We can source some meds from our local Doctor and Hospital.

Medication storage: All medication must be handed over to Hope staff on admission. We generally store all medication in our safe and dispense from the support office at structured times, whether prescribed by your doctor or ours. After a client settles in, we may decide to allow some meds or vitamins deemed harmless, to be taken to rooms and self-supervised.

Narcotic (intoxicants) medications (including pain meds and Benzodiazepines)

Some “mood-altering” drugs and medications (e.g. Xanax/Codeine) are not encouraged in the Hope therapeutic program, as we require all clients to be on a similar emotional level in the community. So, substitutes or careful reduction may be necessary and are effective and manageable. This may require consultation with your doctor or our local doctor. Please let your doctor know about our specific policy regarding this group of medications, as they may be willing to help change medications before you join us.

Anxiety and sleep medication

Beta blockers for enduring anxiety and natural sleep meds are allowed at Hope, so long as they are supervised. Simple and mild medications such as low dose ‘Seroquel’ for short periods can be highly effective in helping clients through difficulties in the early stages of our program. Our resident nurse or hospital doctor will screen anyone requiring such help. The team at Hope have valuable experience and training that we use to help our clients in accordance with accepted good practice.

General medication issues

Many clients arrive on anti-depressants and mood-stabilizers prescribed by their doctors. Clients often ask to stop these meds which is a healthy sign of commitment to recovery. However, Hope staff are not permitted to make these kinds of decisions. So we ask that before coming to Hope you contact the prescribing doctor to get his/her feedback and consent. We can also help you contact the doctor for advice once you have arrived. Family and people close to you may also provide a different perspective so may be consulted. You may additionally be asked to sign a waiver stating that you have taken appropriate advice and are making an informed decision with our support.

Psychiatric medications are very sensitive and must be properly adhered to for safety. We feel it would be irresponsible for Hope staff to allow clients to stop taking psychiatric drugs. If not carefully coordinated by the prescribing doctor, this could trigger unnecessary MH episodes. When making changes to medications, it may also be a good idea to get feedback from those people who are closest to you.

Please arrange to bring the correct supply of your regular medication. Some meds are not available in Thailand or are very expensive and timely to acquire. We suggest at least two months’ supply.

Standard detox (Heroin and Alcohol)

At Hope Rehab we follow common detox protocols for Alcohol and Heroin detoxes. We work together with doctors at our local hospital who provide Diazepam prescriptions for alcohol detox. We also work together with the Bangkok Methadone/Subutex program who provide the prescriptions covering opiate detox and reductions. Some clients bring their own detox medication from their country of origin. Staff at Hope are specially trained by the Royal College of General Practitioners UK to administer and coordinate standard detox programs. We aim to keep all clients safe and comfortable whilst withdrawing. You may be asked to take anti-seizure meds for a short period to ensure safety. For more information please check our detox page.

ADHD & ADD medication

Stimulants such as Adderall, Concerta, or Ritalin are not suited to the Hope community or program. These drugs are far from ideal for addicts as they pump up the human reward system. Some clients who are prescribed these meds have found it triggered their addiction and caused serious life problems so are keen to stop, which we support. Some clients wish to continue using these medications, so we ask them to reduce to a low dose. This is because we have noticed hyper-manic behavior and a lack of emotional connection with others. We suggest Strattera (non-stimulant) as an alternative appropriate ADHD medication. Please let your prescribing doctor know about our policy.

Thank you for your co-operation


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