Addiction, Selfishness, Immaturity and Personality Disorders: The Complex Connection

Addiction is often called a brain disease, and often looks like selfishness—broken promises, emotional manipulation, reckless choices. For family and friends, it can feel like the person they love has been replaced by someone who only cares about getting high or staying drunk.

But addiction is never just about the substance. To truly understand the behaviors that come with it, we need to look at the full picture: how addiction affects the brain, how personality disorders and emotional immaturity complicate recovery, and how healing is possible with the right support.

Addiction is often called a brain disease, and often looks like selfishness

How Addiction Rewires the Brain for Self-Focus

Substances like opioids, alcohol, and stimulants flood the brain with dopamine, hijacking the reward system. The prefrontal cortex—responsible for empathy, impulse control, and decision-making—loses function. The result? A narrow focus on the substance, often at the expense of relationships, responsibility, and self-preservation.

Over time, the brain literally rewires itself to seek the drug above all else. This explains why addiction is sometimes called a disease of priorities—not because people don’t care, but because their brain has stopped recognizing what (or who) actually matters.

According to the National Institute on Drug Abuse (NIDA), over 20 million Americans aged 12 and older had a substance use disorder in 2022. For many, addiction reshapes the brain to prioritize survival through the substance—making the behavior seem obsessively self-centered.

From the Outside: The Experience of Loved Ones

Amy, 34, spouse of a recovering addict:"My husband would disappear for days, drain our accounts, and lie constantly. I felt invisible—like the drugs were the only thing that mattered to him."

This perceived selfishness devastates families and friends. Yet for the person in active addiction, the behavior is often driven by compulsion and impaired emotional processing, not malice.

Addiction’s Impact on Empathy and Emotional Awareness

A 2017 study in Frontiers in Psychology found that people with long-term substance use issues scored significantly lower on measures of empathy and emotional recognition:

• 71% had difficulty identifying others’ emotions.

• 65% said they didn’t fully realize the harm they’d caused until after entering recovery.

These results show that what looks like selfishness is often a sign of emotional blunting caused by addiction itself.

The Hidden Link: Personality Disorders and Addiction

Substance use disorders frequently co-occur with personality disorders, especially:

• Borderline Personality Disorder (BPD)

• Antisocial Personality Disorder (ASPD)

• Narcissistic Personality Disorder (NPD)

  
  

Statistics at a Glance:

• Up to 65% of people with BPD also have a substance use disorder.

• 18–40% of individuals in addiction treatment meet criteria for ASPD.

• Traits associated with NPD—grandiosity, lack of empathy, and fragile self-esteem—can fuel substance misuse as a coping strategy.

Dr. Carla Sharp, Clinical Psychologist:"Personality disorders often predate addiction. If someone struggles with intense emotions, identity issues, or impulsivity, substances can seem like the easiest way to self-medicate. But the long-term effect is a worsening of both conditions."

Untreated Personality Disorders Can Undermine Addiction Recovery

Even after detox or initial sobriety, many individuals relapse—not because they want to use, but because they haven’t addressed the deeper emotional and behavioral patterns underlying their addiction.

• Someone with BPD may relapse after emotional rejection or fear of abandonment.

• A person with ASPD might reject treatment norms or manipulate others in recovery.

• Those with NPD may struggle with humility, accountability, or accepting help.

Jason, 38, in recovery from opioid addiction and diagnosed with BPD:"I got clean three times, but I kept blowing up my relationships and feeling worthless. I realized I wasn’t just addicted—I was emotionally unwell. Once I started DBT [Dialectical Behavior Therapy], things finally started to click."

If the personality disorder isn’t diagnosed and treated, it can sabotage the recovery process—fueling cycles of relapse, isolation, and shame.

Addiction and personality disorders can stunt emotional growth.

Immaturity: The Emotional Freeze That Fuels Addiction

A piece of the puzzle that often gets overlooked is emotional immaturity.

Addiction often begins in adolescence or early adulthood—times when emotional development is still very much in progress. When substance use becomes a coping mechanism, emotional growth can become stunted.

• Many people in active addiction show poor impulse control, emotional overreaction, and a lack of responsibility—traits more common in teenagers than adults.

  
  

• This isn’t just a behavioral issue—it’s a developmental delay. The person stopped growing emotionally when they started numbing themselves with substances.

Penny, 46, recovering alcoholic: "I was 38 when I got sober, but emotionally I felt like I was 19. It took therapy and a lot of humility to realize how immature I’d become—and how many people I’d hurt because of it."

Recovery is often a process of not just getting clean, but growing up—learning how to manage emotions, accept responsibility, and build real, reciprocal relationships.

What Real Recovery Looks Like: Rebuilding Empathy and Accountability

Comprehensive treatment that addresses both addiction and co-occurring mental health disorders is key. This might include:

• Dialectical Behavior Therapy (DBT) for emotional regulation (especially for BPD)

• Cognitive Behavioral Therapy (CBT) for distorted thinking and impulsivity

• Peer support groups that foster accountability and empathy

• Medication-assisted treatment (MAT) to manage cravings and stabilize mood

Derek, 41, recovering alcoholic:"When I got sober, I started to feel again—and it hurt. Therapy taught me how to sit with those feelings instead of running from them. That’s when I started becoming a better dad and partner."

The Takeaway: It’s Not Just About the Drug

Addiction often looks selfish on the outside—but underneath is a tangled web of brain chemistry, emotional immaturity, trauma, and sometimes personality disorders. If we only see the surface-level behavior, we miss the opportunity for real healing.

But with the right treatment, people can recover—not just from the substance, but from the distorted behaviors and thinking that came with it. Recovery is about more than staying clean. It's about learning how to feel, connect, and live fully again.