Avoidant Personality Disorder and Substance Abuse

On a regular morning, an average person might leave home, buy a frothy beverage at a coffee shop, pop into a crowded subway and then stroll into the office. These little steps might involve interactions with dozens of strangers, and the thought of working with those people might make anyone uncomfortable.

In fact, an article produced by Medscape suggests that as many as 40 percent of Americans struggle with shyness from time to time.

Social interactions are just difficult and hard to predict, and they can fill even the most confident person with a mild case of the jitters.

There are some people, however, who are profoundly shy in almost any social context, and the way in which they behave has a serious and negative impact on their mental health and on their chances for success in later life. People like this might be diagnosed with avoidant personality disorder (APD), and they might develop substance abuse issues in a mistaken attempt to deal with their pain.

Early Onset

People with APD often struggle with social situations when they’re quite young. As toddlers, they might shrink from the touch of a stranger or cling to the legs of their parents when they’re out in crowds. When these young people go to school, they tend to avoid extracurricular activities, and instead look for opportunities to be alone. These might be young people who spend time buried in a good book at recess, rather than running and playing with friends. They might spend weekends playing computer games, rather than riding their bikes through the streets with their neighbors. In time, their families might come to think of these children as loners or shy people. The behavior just seems a normal part of the spectrum for that child.As adults, however, this sort of avoidant behavior can have a deep impact on a person’s ability to function in the world. People like

this find the idea of living in a dorm terrifying, and they might not go to college as a result. Working in the community might also be out of the question, as these people might not be able to conduct themselves properly during an interview, and they might not be able to take orders from clients and members of the public.

Even though the disorder seems to be rooted in childhood behaviors, and even though it might seem normal for that person, the persistent fears and concerns that run alongside this disorder can make life as an adult absolutely miserable. As a result, according to an article in Psychiatric Times, this disorder is associated with a significant amount of both physical and psychiatric pain. In fact, the level of pain people with APD endure might be higher than the level endured by people with very serious mental illnesses, including major depression.

Common Avoidant Behaviors

People with avoidant personality disorder watch others around them quite closely, and they feel as though they don’t quite match up to the talents and skills of the people they see. They may also be intensely worried about being criticized or rejected by the people they meet, and they may take offense to statements that others might consider completely benign. As a result, people like this might:

  • Avoid intimate relationships, even though they desperately want to be loved
  • Speak little when forced to participate in a social situation
  • Develop few friendships
  • Steer clear of jobs that involve social interactions

Just thinking about interacting with other people can fill someone with APD with a sense of terror.

This person might become convinced that something terrible will take place just as soon as the social interaction begins, and the person might be willing to do almost anything to avoid that situation.

Living with someone with avoidant personality disorder can be difficult, as some family members feel as though the person they love is emotionally remote and inaccessible. The person might not share his or her feelings openly for fear of being rejected, but the family might feel as though the person isn’t listening or doesn’t care. Someone with APD might also be incapable of reaching out and making connections, so the person might seem polite but distant. In time, if the person lives in a separate residence, the family might not see the person at all, as this person might avoid all family functions due to fear.

Failed Attempts to Heal

The National Institute of Mental Health reports that about 5.2 percent of the adult population in the United States has avoidant personality disorder, and it’s likely that each person with the disorder has his or her own tried-and-true methods for dealing with the distress the mental illness can cause.

There are some behaviors that seem common to most people who have this disorder, however, and many of them seem intensely harmful.

Many people with APD lean on drugs and alcohol in order to deal with social situations, for example. They may feel intensely nervous when a party begins, so they may head right over to the punch bowl for a big dipper of drink, or they might take drugs before they even set foot in the room, attempting to amend their chemistry so the evening runs a bit more smoothly. People with APD might even begin to take in drugs and alcohol before leaving the house, so they can handle routine tasks like paying for a taxi or talking to coworkers without feeling as though they’ll be rejected or judged. People who take in large amounts of addictive substances on a regular basis run the risk of developing an addiction, and it’s easy to see why people with APD often fall prey to this problem.

Similarly, people with APD may just spend a significant amount of time alone. Even though they may want to be with others, and even though they may long for the day in which they have a large circle of friends they can share their lives with, they may be so isolated and so uncomfortable that they can’t get what they want. These loners might also begin to dabble in substance use and abuse in attempt to infuse their lives with a touch of happiness.

Therapy Techniques

People with avoidant personality disorder rarely experience spontaneous, self-directed healing. They’ve spent most of their lives avoiding others and feeling shy, and they can’t simply turn off those avoidant behaviors and begin acting in a whole new way. This is especially true if their minds are clouded with drugs and alcohol. People like this need therapy in order to learn how to manage their thoughts, overcome their fears and participate in the social world that surrounds them.

In a treatment program for APD, clinicians help their patients to:

  • Vocalize their worries about interacting with others
  • Confront those concerns directly
  • Find new ways to soothe their minds when they feel distress
  • Slowly become comfortable with social situations


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This kind of work takes time, but it can be remarkably effective. For example, in a study in the Journal of Consulting and Clinical Psychology, researchers found that those with APD who participated in a 10-week counseling program made huge improvements in their feelings of distress in social situations, but the researchers warn that longer treatment plans might be needed in order for people to really reach a level of functioning that experts would consider ideal. There’s just a lot to learn, and it’s possible that people can’t make enough progress with a short course of therapy.

People with personality disorders and substance abuse disorders can also benefit from therapies that help them to understand the nature of addiction, and to develop skills that can help them to stay sober in the future.

In a study of this kind of therapy, in The American Journal on Addictions, researchers found that people with personality disorders were able to decrease their use of substances significantly with the help of a therapist. In their sessions, they might learn more about how addictions boost isolation, not connectedness, and they might feel empowered to leave substances of abuse behind when they feel weary or worried.

How to Help

Even though therapy can be an amazing help for people with APD, it can be difficult to persuade people like this to get care. People like this are constantly on the alert for statements that seem critical or damaging, so discussing behavior might make the person feel attacked. Similarly, people with APD might be remarkably resistant to the idea of talking to a stranger about their thoughts. Just bringing up therapy might make the person’s behavior escalate.

Hiring an expert interventionist might be helpful, as this professional can help the family to approach the issue in a way that’s both respectful and helpful. An interventionist can also help the family to understand the ways in which an addiction and a mental illness can change the person they love, and this education might allow the family to approach the person with understanding, rather than with criticism.

Find Out More

If someone you love has avoidant personality disorder, and that behavior is complicated by a substance abuse issue, we’d like to help. We specialize in helping families dealing with Dual Diagnosis situations like this, and with our help, you can find the right program for the person you love and get the enrollment process started right away. Please call us to find out more.

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