By Dr. Robert Moran
It’s very important to know the difference between someone acting like a sociopath and someone who is a sociopath but also happens to suffer from addiction too. They are two different types of conditions.
During childhood a sociopath has a condition known as conduct disorder. This is a condition in which the child does not follow rules, is aggressive toward others and toward animals, starts fights, uses weapons, is cruel, steals, destroys property, starts fires, lies, defies authority, is truant from school, etc.
Throughout adolescence, this may develop into antisocial personality disorder, which is a pattern of disregard for the rights of others, along with three or more traits including deceitfulness, impulsivity, aggressiveness, recklessness, irresponsibility, and lack of remorse. There is little to no evidence of effective treatment for antisocial personality disorder. So, you cannot really completely cure a sociopath, to date.
Back to addiction. The person suffering solely from addiction is a different case entirely. The disease of addiction has advanced to the point where it has hijacked the brain. The person will now do whatever it takes to seek out and obtain the substance, regardless of the consequences. Like a sociopath, the outcome looks the same: This person breaks laws, lies, steals, manipulates and violates the rights of others. On the surface, this looks like pure sociopathy, but it’s being driven by a brain in need of a substance. Ultimately, the only way to distinguish this behavior from sociopathy is to successfully treat the addiction.
This means that a recovered addict will regain his or her ability to feel remorse, will become less likely to lie or manipulate, and break laws. A true sociopath, however, even after recovering from addiction will not change the behavior. They will be sober, but they will still be a sociopath, which carries a poor prognosis for recovery.
In my own experience, I have treated many of these cases. One example was, let’s call him, Patient X. He was a single, white male in his 30’s with a history of opioid use. He desired treatment to help him stop using drugs and claimed he wanted to become a productive member of society. He had been to many treatment programs but was unable to maintain abstinence from drugs.
His typical time in rehabs would be like this: He would go through detox, usually using the medicine buprenorphine over the course of 6-7 days, which was then abruptly stopped and he was then transferred to a different level of care, with no further medicine. This usually left him with an overwhelming craving for opioids. Although he typically initially resisted, it always resulted in him finding some way of finding drugs—either pain pills or heroin from a drug dealer on the street somewhere. He would use out on the street and return to a rehab and not tell anyone. This would continue until he would be found out, usually by urine drug screen, at which point he would be asked to leave whatever program he was in at the time.
When he arrived at our program, his history was significant for typical sociopathic behaviors—dishonesty, stealing, no significant job history, multiple arrests, repeated physical fights, no consistent place of residence. However, it was unclear to what extent this was all related to his addiction. He appeared motivated for treatment. There appeared to be a superficial charming nature about him.
He went through withdrawal which we stabilized with buprenorphine, and we tapered him off, which wasn’t done at other rehabs. We tapered him according to the research evidence and present national guidelines. He progressed to the Intensive outpatient level of care. At this level patients are expected to obtain a part time job in order to take on responsibility and pay rent.
This is where his character traits began to shine.
Patient X, now in full recovery from drugs, began to make excuses for why he could not search for jobs. His roommates started reporting certain items were missing in their apartment. All the evidence started pointing toward Patient X. A number of other patients began getting into arguments withPatient X and staff members had to intervene to prevent physical altercations. Even when it became obvious that Patient X was clearly wrong for starting an altercation, he showed no remorse.
On one occasion, he acknowledged having stolen a watch from his roommate and showed no remorse and refused to apologize. He began to tell the staff that he felt he was entitled to remain in the apartment without the requirement of having to pay rent, and was indignant when told that he would have to leave if he did not immediately obtain a job to begin earning money. He was given a deadline which he did not meet and he was forced to leave.
So, it was only with time and the course of events that revealed the distinction between an addict and a sociopathic addict.
Robert A Moran, MD, FAPA, FASAM, is CEO and Medical Director of the Family Center For Recovery in Latana, Florida. He is also Diplomate, American Board of Psychiatry and Neurology; Certified in General Psychiatry and Addiction Psychiatry; Diplomate, American Board of Addiction Medicine; Certified in Addiction Medicine; Voluntary Assistant Professor of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine; Clinical Assistant Professor of Psychiatry, Nova Southeastern University; Clinical Professor, Marietta College; and Assistant Professor, Eastern Virginia Medical School. Contact Dr. Moran at 561-296-5288 or FCFRmd.com.