Alcohol Use Disorder and Schizotypal Personality Disorder

Alcohol and schizotypal personality disorder is a dangerous combination that not only increases the risk of dependence but also lowers the chance of breaking free from addiction.

What You’ll Learn:

• What schizotypal personality disorder is and key statistics

• The common characteristics of STPD

• What research has found about the link between STPD and alcohol use

• Why schizotypal personality disorder increases the risk of alcohol dependence

• How people with schizotypal personality disorder can overcome AUD

Schizotypal personality disorder (STPD) is a part of the Cluster A personality disorders. With STPD a person has pervasive social and interpersonal deficits alongside cognitive or perceptual distortions and eccentric behavior.

It’s a somewhat uncommon personality disorder with a 3.9% lifetime prevalence, although it’s higher for men than women.

Alcohol use disorder is more common across every personality disorder, not just this one. Our guide to alcohol use disorder and personality disorders breaks down the risk and the research for each one.

Of all the personality disorders, STPD has the most striking overall comorbidity with alcohol use disorder (AUD).

STPD isn't just linked to developing AUD, it's one of only a few personality disorders shown to predict long-standing alcohol dependence that’s hard to break.

Schizotypal Personality Disorder Characteristics

Every personality disorder is defined by characteristics and traits. With schizotypal personality disorder the nine identified characteristics are:

• Ideas of reference

• Odd beliefs or magical thinking inconsistent with subcultural norms

• Unusual perceptual experiences

• Odd thinking and speech

• Suspiciousness or paranoid ideation

• Inappropriate or constricted affect

• Odd or eccentric behavior/appearance

• Lack of close friends outside immediate family

• Excessive social anxiety tied to paranoid fears rather than negative self-judgment

For a STPD diagnosis a person must have at least five of the traits above. There’s actually been debate over whether STPD should be classified as a personality disorder or a part of the schizophrenia spectrum.

There is a genuine genetic and phenomenological overlap given that people are more likely to have schizotypal personality disorder if a first degree relative has schizophrenia.

What the Research Says About Alcohol Use and Schizotypal Personality Disorder

Even though alcohol use disorder is more common among people with just about any type of personality disorder, STPD actually has the highest comorbidity rate.

The NESARC Wave 2 study revealed staggering co-occurrence rates among people with schizotypal personality disorder, and not just with AUD. The study found that among people with STPD:

• 67.5% had a co-occurring substance use disorder

• 67.6% had a mood disorder

• 72.3% had an anxiety disorder

• 82.7% had at least one other personality disorder

Given the connection between alcohol misuse and mood disorders, anxiety and personality disorders it’s not surprising that many people with STPD struggle with substance abuse.

NESARC researchers reported that schizotypal, dependent and borderline personality disorders had the highest baseline rates of alcohol dependence.

But that isn’t even the most substantial finding. A 3-year follow-up study went deeper with the data to look at not only the rate of alcohol dependence with the different personality disorders but the likelihood of recovery.

The follow-up study examined people who had been dependent on alcohol for 12 months.

Three personality disorders had a significantly high rate of non-remitting alcohol dependence three years later, and schizotypal personality disorder was one of them.

The same three personality disorders have predicted persistence of drug use disorders and nicotine dependence as well.

In other words, with schizotypal personality disorder it isn’t just about the risk of developing alcohol dependence, it's about the difficulty of recovering once dependence sets in.

Why Schizotypal Personality Disorder Carries Such Risk For AUD

Unfortunately, there isn’t a lot of research specifically examining why there’s such a strong connection between STPD and alcohol dependence. The theories that exist are largely based on the broader schizophrenia-spectrum substance-use literature.

It points to a cause that is common with personality disorders - self-medication.

It’s believed that there’s a high prevalence of alcohol abuse among people with schizotypal personality disorder because alcohol is used to:

• Blunt chronic social anxiety

• Ease discomfort in the interpersonal situations

• Dampen distressing perceptual or cognitive anomalies

There could also be a neurodevelopmental or genetic vulnerability at play, but that theory is far from proven. From what we know, drinking is a result of the symptoms from STPD that the person is trying to manage on their own.

Treating Alcohol Use Disorder When You Have Schizotypal Personality Disorder

If you’re diagnosed with schizotypal personality disorder the silver lining is that pharmacological treatment does exist. Atypical antipsychotics are commonly used to lessen anxiety and psychotic-like symptoms.

And antidepressants can be used to treat social anxiety.

Cognitive behavioral therapy (CBT) is also highly recommended. CBT for STPD usually emphasizes social skills and reality-testing.

Supportive psychotherapy is another therapeutic approach that can be beneficial for managing schizotypal personality disorder with or without alcohol use.

But that’s just one half of the equation that needs to be addressed.

For someone with schizotypal personality disorder abstaining from alcohol is a smart choice given the risk of developing a dependence.

Anyone who has already developed a drinking problem needs to get a handle on it immediately since it’s already more difficult to control alcohol use with STPD.

Overcoming alcohol use disorder isn’t a matter of willpower. There are psychological and physical effects that make it difficult to control drinking once dependence has started.

One-on-one counseling with an addiction specialist can certainly be of benefit. However, the effectiveness of group therapy for addiction can depend on the individual.

It can help build social skills, but patients with prominent paranoid thinking may find group settings genuinely difficult to tolerate and hinder treatment adherence.

FDA-approved medications for alcohol use tackle addiction from another angle. There are several medications available through a prescription, but naltrexone is considered the gold standard for getting drinking under control.

Naltrexone is proven to curb alcohol cravings by blocking opioid receptors that respond to alcohol use. The result is that dopamine isn’t released and the euphoric buzz of alcohol isn’t there.

Because of this, alcohol becomes less effective for self-medicating.

On top of that, over time naltrexone helps rewire reward pathways so that the alcohol isn’t associated with pleasure anymore. As the reward pathway is altered, alcohol cravings subside and it becomes easier to drink less.

The reduced consumption helps address alcohol dependence that causes a physical need.

Naltrexone medication can be used to simply cut back on drinking or abstain completely. The recommendation for people with STPD is total sobriety. Completely abstaining from alcohol is the most effective way to overcome physical dependence.

Choose Your Horizon is a trusted online naltrexone provider that can help people with schizotypal personality disorder control alcohol use in a confidential and supportive way.

Everything is handled virtually from the comfort of your own home, which is hugely beneficial for anyone who is experiencing social anxiety or paranoia.

The first step to finding out if getting a naltrexone prescription online is possible is taking our Alcohol Use Assessment.

It only takes a few minutes, and you’ll receive an Audit-C score that can provide insight into the best ways to address problematic drinking behaviors.