Paranoid personality disorder and drug use often co-occur. People with paranoid personality disorder frequently start using substances to find relief from their distress.

Approximately 62 percent of people who receive treatment for a substance use disorder have a co-occurring personality disorder, and paranoid personality disorder (PPD) is one of the most common. These disorders can create barriers that prevent people from entering treatment. However, with integrated treatment, people can address both conditions and improve their quality of life.

Drug Abuse as a Hindrance to Paranoid Personality Disorder Treatment

People with paranoid personality disorder often don’t seek treatment on their own. The nature of the disorder makes it hard for people to recognize that their symptoms indicate a mental health condition. Their characteristic mistrust of others makes them less likely to reach out to professionals. Substance use compounds these obstacles, making it less likely a person with paranoid personality disorder will seek treatment. Substance use can also distort paranoid personality disorder symptoms and make detecting and treating them tougher.

Effects of Substance Abuse on Paranoid Personality Disorder Symptoms

Symptoms of paranoid personality disorder include thoughts, statements or actions rooted in misplaced or unsupported suspicions of others. People with paranoid personality disorder often suspect others of betrayal, read threatening messages into neutral statements, hold grudges and react aggressively to perceived slights. Worrying and obsessing over their suspicions and fears often causes people with paranoid personality disorder to develop secondary anxiety and depression.

Paranoid personality disorder and drug use often co-occur. People with paranoid personality disorder frequently start using substances to find relief from their distress. Alcohol and drugs with a sedative or calming effect can diminish anger that people with paranoid personality disorder feel over a suspected betrayal. They can also reduce anxiety and obsessive rumination.

Unfortunately, these effects are temporary and are usually followed by an intensification of the uncomfortable mental states they were used to alleviate. They can also lower inhibitions so that people with paranoid personality disorder feel empowered to act on their anger in ways that can be harmful to themselves or others.

Paranoid Personality Disorder and Alcohol

Having paranoid personality disorder and drinking alcohol can seem beneficial at first. Alcohol is readily accessible and has a host of effects that can help people with PPD find temporary relief from their symptoms. These immediate, positive effects camouflage the underlying dangers of co-occurring paranoid personality disorder and addiction.

While alcohol can alleviate anger and induce a mild sense of euphoria, drinking alcohol does not always cause a person with paranoid personality disorder to feel calm. Sometimes, the disinhibiting effects can spur people to act on their paranoid thoughts in dangerous ways. It can even make some individuals who have paranoid personality disorder and are alcoholic resort to violence.

Alcohol can worsen the symptoms of paranoid personality disorder in other ways. The residual anxiety and depression that arises in periods between alcohol use can heighten rumination and paranoia. Alcohol can also cause health complications requiring medical treatment that people with paranoid personality disorder may avoid, leading to negative health outcomes and other complications.

Paranoid Personality Disorder and Opioids

Parnoid personality disorder and pain medication abuse may co-occur for similar reasons as co-occurring PPD and alcohol use. Opioids are often preferred by people who are seeking relief from states associated with paranoid personality disorder like anger and agitation. It is not unusual for people who are prescribed opioids for physical pain to start abusing them to address psychological issues and to eventually develop an opioid addiction.

The euphoria that opioids can induce might be the first good feeling people with paranoid personality disorder have felt in a long time. This temporary glimpse of a less-hostile world can drive people to start abusing pain medication and is one of many ways that paranoid personality disorder and drug addiction co-occur.

Paranoid Personality Disorder and Marijuana

Marijuana’s growing social acceptance is making it an increasingly popular choice for people who want to use a substance to relax or improve their mood. Unfortunately, marijuana has potentially harmful side effects, especially for individuals with pre-existing mental health conditions. Prolonged marijuana use can have negative effects on cognition, and some people may experience extreme anxiety and panic attacks while using the drug.

Marijuana can pose a risk to people who grapple with paranoid personality disorder, as consuming it may increase paranoid thoughts. Marijuana-induced paranoia can intensify the symptoms of paranoid personality disorder, even to the point of triggering episodes of panic or violent behavior.

People with paranoid personality disorder who use marijuana regularly may experience dissociative episodes more often. In these states, people feel disconnected from their thoughts, feelings and bodily sensations or as if the world is unreal. This puts them at a greater risk of acting on paranoid thoughts and suspicions.

Paranoid Personality Disorder and Stimulants

Stimulants can make someone feel more powerful in ways that are dangerous for people with paranoid personality disorder, who are at risk of acting on paranoid thoughts while under their influence.

Taking stimulants in high doses raises an individual’s risk of developing stimulant psychosis, which can intensify paranoid thoughts and even trigger hallucinations. This may cause people with paranoid personality disorder to have symptoms that resemble schizophrenia. In addition to putting them at risk of acting in ways that could harm themselves or others, it can also lead to misdiagnosis during treatment.

Even when stimulants do not trigger such an extreme reaction, they generally worsen symptoms of anxiety and paranoia in ways that are particularly detrimental to people with paranoid personality disorder.

Statistics on Paranoid Personality Disorder and Drug Abuse

The most common comorbid personality disorders are borderline and antisocial personality disorders, which have prevalence rates near 15 percent. Among the Cluster A personality disorders, which are characterized by unusual patterns of thought and behavior, paranoid personality disorder is the most common. Anywhere from 4.4 to 10 percent of people receiving addiction treatment have co-occurring paranoid personality disorder.

Paranoid personality disorder is especially common for people with alcohol use disorders. The National Epidemiological Survey on Alcohol and Related Disorders found paranoid personality disorder to be the third most prevalent personality disorder for people with an active alcohol use disorder, with 10 percent of people receiving treatment for alcohol addiction also meeting criteria for a PPD diagnosis.

Drug Abuse as a Cause of Paranoid Personality Disorder

Can drugs cause paranoid personality disorder? The answer to this question is simple: they cannot. Personality disorders begin developing in childhood and emerge in full by late adolescence or early adulthood. In rare cases, drug use during adolescence can contribute to the development of a personality disorder, but other factors must be present. These include genetic, biological and environmental factors.

Personality disorders are strongly linked to trauma. People with the following risk factors are most likely to develop paranoid personality disorder:

  • Family histories of paranoid personality disorder, other Cluster A personality disorders or psychotic disorders
  • Being a witness or victim of violence or other kinds of abuse
  • Growing up in families with emotionally distant communication styles

While drug use cannot cause paranoid personality disorder, it can trigger the onset. Substances that cause or intensify paranoia can cause people with a predisposition toward the disorder or who have paranoid personality traits to develop PPD more quickly than they otherwise would have.

Treating Paranoid Personality Disorder and Co-Occurring Substance Use Disorders

Many people with paranoid personality disorder receive treatment for the first time when they undergo addiction treatment. Clinicians may notice that they are guarded in group treatment and frequently express suspicion of others. This can lead to an individual’s first paranoid personality disorder diagnosis.

Outcomes are better for people with paranoid personality disorder and co-occurring substance use disorders when treatment focuses on factual information and rational insight. Cognitive behavioral therapy methods that emphasize learning how to avoid triggers, control cravings and challenge paranoid thoughts are more likely to resonate with people who have PPD.

It’s important for people with paranoid personality disorder and co-occurring disorders to receive integrated treatment that targets symptoms of both disorders. This means they ideally will be able to participate in coordinated individual, group and complementary therapy.

The Recovery Village operates rehab facilities across the United States that provide integrated treatment to people with co-occurring disorders. If you are concerned that you or a loved one is struggling with addiction and paranoid personality disorder, contact a representative from The Recovery Village for help locating a facility that can meet your treatment needs.

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Editor – Megan Hull
Megan Hull is a content specialist who edits, writes and ideates content to help people find recovery. Read more
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Medically Reviewed By – Stephanie Hairston, MSW
Stephanie Hairston received her Bachelor of Arts degree in Psychology and English from Pomona College and her Master of Social Work degree from New York University. Read more
Medical Disclaimer

The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.