Have you ever wondered why some people don’t seem to make it through treatment first time around, while others do? These individuals’ treatment episodes are plagued with either minuscule or catastrophic problems that seem to shake the very foundations of their program while also directly affecting those around them. They might be identified as the “problem clients” or the “dramatic clients”. While to the untrained eye these people might come off superficial, confrontational, and/or annoying; however, to the trained eye, namely, the clinician’s, these features need to be understood as the very things that perpetuate and preserve the addicted lifestyle. In case you haven’t guessed, we are talking about Personality Disorders (PD’s). PD’s permeate the recovery field’s work and can present confounding and frustrating barriers to any clients getting and staying safe from lapse or relapse conditions. Antisocial, Narcissistic, Histrionic, Borderline traits and states are underlying turbulent issues; core treatment concerns which addiction treatment professionals ought to look for and tease out in their ongoing assessments. I believe the PD’s are greatly underestimated in treatment and often go unobserved in the souls of those seeking help. Prevalence of PD’s are common problems universally—but appear more markedly in addiction assessments of clients entering treatment. PD’s are marked by and demonstrate rigidities and inflexibilities of thought and principles of ones life and others leading to pervasive impairments of functioning and severely distressed relationships surrounding those struggling with PD’s. Great are the complications of PD’s and great are the conflicts with the population bearing these disorders—crushing self-esteem–enhancing relative states of guilt, stress, shame, and negative affect. Recovering people and the professionals that treat them ought to pay very close attention to potential PD diagnosis criteria, and the notion that these things can present themselves as the confounding variable in treatment drop out and chronic relapses. PD’s may just be the missing iota in the treatment minutia of difficult cases that substance abuse treatment professionals are working with yet unaware of. Check out your DSM 5 manuals and be awake and aware to the ideas that when you are dealing with addiction, you may well be in the neighborhood of needing to ferret out some very problematic and complicated pieces to your clients treatment needs – namely those of the personality disorders type.