Alcoholism and personality disorders

November 28, 2021

By Andy F

Categories: problems other then alcoholism

Similarities and differences

In meetings worldwide, the AA preamble is read as a formal introduction to every meeting.

……” Alcoholics Anonymous is a fellowship of men and women who share their experience, strength, and hope with each other that they may solve their common problem and help others to recover from alcoholism.”

Unquestionably, our ‘common’ problem is alcoholism. 

Newcomers are encouraged to listen for the ‘similarities and not the differences.’  Members hear this statement at the beginning of every AA meeting. Listening to other members share gives them the hope that ‘There is a solution.’ (This is the title of chapter two in the AA Big Book).

Sober alcoholics can then share their experience, strength, and hope. This type of sharing creates unity and a sense of belonging. For AA members who don’t believe in God, this feeling of unity can become a power greater than that of the newcomer.

Confusion arises

Concerning our alcoholism, there are striking similarities in our pathologies as alcoholics. Sometimes, this commonality can lead some members to have a very mistaken idea. They believe that because we suffer from a ‘common’ illness and share ‘similarities’ as alcoholics, we are all the same. Yes, alcoholics do have the disease of alcoholism in common. However, each one of us comes into recovery with very different issues.

We all vary in the degree to which we are ill and our recovery rate. There is one point on which we can all agree. Ultimately, our solution as alcoholics is the spiritual healing available through the twelve steps.

As an agnostic, I have learned an essential thing about sobriety. Spiritual healing is not necessarily dependent on the need to believe in God. Recovery is a journey from a conflicted inner duality to peace and happiness.

The spiritual malady

Bill Wilson, one of the founders of AA, makes a radical statement in chapter five of the Big Book:

“When the spiritual malady is overcome, we straighten out mentally and physically.”

(BB p.64).

The suggestion here is that although alcoholics have been physically and mentally ill, the root cause of our disease is spiritual. Some of us come to AA with grave physical consequences. Others are more affected mentally. Do we also differ in the degree to which we have been spiritually sick? That’s an interesting question.

The fundamentalist view in AA

Sadly, something alarming is happening in AA. Some of the more fundamentalist members have misinterpreted two keywords woven into our AA language; “Common” and “similarities.”

They believe that whatever appears to be working for them must also work for every alcoholic.

These members believe that our common illness as alcoholics requires a blanket approach to recovery from alcoholism.

Problems other than alcohol

Can we say that all of the issues affecting alcoholics respond to the spiritual solution? Does everyone recover from mental instability when we commit to the spiritual program of action?

This question has created a heated dialogue amongst some AA members. It has often been the cause of resentment, conflict, and mistrust within our ranks.

What about those alcoholics who come into recovery with coexisting mental health issues? What about those who are alcohol dependent but are also diagnosed with a personality disorder?

Borderline Personality Disorder (BPD)

Initially, staying clean and sober was an impossible task. I had to seek outside psychiatric help. The doctor prescribed medication, helping me to remain clean and sober. It made recovery tolerable. Later on, I received two new diagnoses on top of my chemical dependency.

The first of these was Borderline Personality Disorder. Here are the diagnostic criteria for BPD. You will find them in the DSM 5. Its full title is the Diagnostic and Statistical Manual of Mental Disorders. It is a work that the American Psychiatric Association produced.

This was the challenge that I faced trying to stay clean and sober with BPD.

  • Chronic feelings of emptiness.
  • Emotional instability in reaction to day-to-day events. (Intense episodic sadness, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
  • Frantic efforts to avoid real or imagined abandonment.
  • Identity disturbance with markedly or persistently unstable self-image or sense of self.
  • Impulsive behavior in at least two areas that are potentially self-damaging. Spending, sex, substance abuse, reckless driving, binge eating).
  • Inappropriate, intense anger or difficulty controlling anger. Frequent displays of temper, constant anger, recurrent physical fights).
  • The pattern of unstable and intense interpersonal relationships. Extremes between idealization and devaluation characterize these. (Also known as “splitting”).
  • Recurrent suicidal behavior and gestures. Threats or self-harming behavior
  • Transient, stress-related paranoid ideation. Severe dissociative symptoms. (Paraphrased from the DSM 5)

You can imagine how frustrating it was when certain members told me that all I needed to do was get a sponsor, stop taking my meds, and work the steps. In the London fellowship in the early 90s, this is the type of advice given by a small but potent minority in AA believed was the solution for every alcoholic coming into recovery.

Thankfully, there is always a large selection of meetings, and members with coexisting mental health problems can avoid this type of closed-minded fundamentalism.

Complex Post Traumatic Stress Disorder (CPTSD)

The second diagnosis I received sometime later was CPTSD. Complex/childhood Post Traumatic Stress Disorder. I received this diagnosis from an addiction therapist.

Although technically not accepted as a personality disorder, it is nevertheless another mental health issue that was identified on top of my alcoholism.

“The C-PTSD criteria have not yet gone through the private approval board of the American Psychiatric Association (APA). It has not yet been included in the Diagnostic and Statistical Manual of Mental Disorders. (DSM)” Wikipedia

These two disorders made it very difficult for me to function normally. I couldn’t hold down a job or sustain relationships, especially when I got too close to someone and became emotionally involved.

Two illnesses

Eventually, I recognized that my alcoholism was an illness. As an agnostic, I even embraced the idea that, at its very core, it is a spiritual illness. I accepted this because some problems failed to respond to conventional therapies. Amazingly, AA’s spiritual solution took my recovery to a new level.

The twelve steps are spiritual tools. When I was ready, they provided a powerful complementary therapy. Going through the steps with a sponsor helped me find a new peace and contentment.

I accepted that I had two illnesses: the disease of alcoholism and coexisting personality disorders. They both required entirely different treatment approaches.

Learning how to regulate the dysregulation

Both Borderline Personality Disorder and Childhood Post Traumatic Stress Disorder responded to a greater awareness of the symptoms of these disorders. I gradually developed the skills to manage my chaotic internal world.

Dramatic mood swings, racing thoughts, and overwhelming emotions are common symptoms. Medication was an essential part of treatment. I learned to adapt and function more successfully in and out of the fellowship.

Twelve steps to freedom

Any literature about BPD and CPTSD will tell you that these disorders are the result of early childhood trauma. Although this is an undeniable fact, to treat my alcoholism, I had to stop blaming my childhood.

AA’s program of action is helping me to grow up and become a mature and responsible adult. Steps four and five helped me to stop seeing myself as a victim. This very negative belief created all kinds of problems in my sober life.

“We had to drop the word blame from our speech and thought.”

(12&12 p.47)

Freedom from the bondage of self

Going through the program with a sponsor was ideal to achieve this objective. I am learning to stop reacting to life like a wounded child. It’s not an overnight process. Recovery requires a daily change in perspective. It’s not a coincidence that in AA, alcoholism is also known as ‘the disease of perception.’

Compared to the person I was when I first got sober, the twelve steps have set me free. They are helping me to achieve contented long-term sobriety. Surprisingly, the twelve steps have also helped to overcome the symptoms of my personality disorders.

In fellowship

Andy F


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