Borderline Personality Disorder and Substance Abuse

Borderline personality disorder (BPD) and substance abuse often need to be treated simultaneously. Half of people with borderline personality disorder have active substance use disorders, which increases the risk that they will engage in self-destructive behavior, harm themselves or attempt suicide. Fortunately, there are effective treatments available for both conditions.

Borderline personality disorder (BPD) and substance abuse often need to be treated simultaneously. Half of the people with borderline personality disorder have active substance use disorders, which increases the risk that they will engage in self-destructive behavior, harm themselves or attempt suicide. Fortunately, there are effective treatments available for both conditions.

Effects of Substance Abuse on Borderline Personality Disorder Symptoms

Borderline personality disorder symptoms, also known as BPD traits, include the following:

• Rapid changes in mood with episodes of dysphoria, rage or transient dissociation
• Intense emotional reactivity, especially to real or perceived abandonment
• Self-destructive and high-risk behavior, including self-harm and suicide attempts
• Interpersonal difficulties, including a pattern of intense and unstable relationships
• Chronic feelings of emptiness
• An unstable sense of self

Borderline personality disorder is primarily a disorder of emotional regulation. People with this condition frequently experience intense and painful emotional reactions they can’t slow down or control.

One of the reasons self-harm is a common feature of borderline personality disorder is that physical pain can serve as a distraction from or an expression of intense emotional pain. Substance use provides an alternative way for people with borderline personality disorder to experience relief from these distressing emotional states.

Unfortunately, this relief is only temporary. People with borderline personality disorder typically have trouble controlling self-destructive impulses, and substance abuse only further increases disinhibition. This can lead to a number of problems, including emotional crises and intentional acts of self-harm.

People with borderline personality disorder already have an elevated risk of suicide and substance abuse increases that risk. As addiction advances for someone with borderline personality disorder, their already unstable sense of self is further undermined. The destabilizing impact of substance abuse on relationships frequently leads to interpersonal conflict that is especially distressing for people with borderline personality disorder.

Drug Abuse as a Cause of Borderline Personality Disorder

Substance abuse alone cannot cause borderline personality disorder, but it can aggravate it and hasten its progression. This is especially true when substance abuse occurs in adolescence, the primary period in which borderline personality disorder emerges.

Adolescent substance abuse puts teenagers at risk of victimization and interpersonal chaos. In response, they can become alienated from parents and peers. When a young person who has suffered trauma cannot achieve a sense of safety, even at home, they are much more likely to seek rescue through romantic relationships and to grow desperately afraid of losing them. This pattern can hasten the development of borderline personality disorder.

Statistics on Borderline Personality Disorder and Drug Abuse

A little more than half of people with borderline personality disorder have substance use disorders at the time they receive treatment for their mental health condition. Nearly 75 percent of people with borderline personality disorder have a substance use disorder at some point in their lifetimes.

About 24 percent of people with borderline personality disorder have an alcohol use disorder. Excessive or “binge” alcohol use is especially common for people with borderline personality disorder—18 percent of people with borderline personality disorder meet clinical criteria for alcohol dependence at the time of treatment. A little more than 40 percent of people with borderline personality disorder meet criteria for alcohol dependence in their lifetimes.

Approximately 13 percent of people with borderline personality disorder have a substance use disorder involving a drug other than alcohol at the time they receive treatment. More than 36 percent of people with borderline personality disorder have a drug use disorder during their lifetimes.

Borderline Personality Disorder and Alcohol

Borderline personality disorder and alcohol dependence are strongly linked. People with borderline personality disorder abuse alcohol at higher rates than any other substance. This may be due to the social acceptance and availability of alcohol or may reflect the particular efficacy of alcohol in relieving symptoms of borderline personality disorder.

Alcohol can seem to temporarily reduce anxiety and lower social inhibitions, helping people feel more open to others. However, disinhibited behavior that occurs during alcohol intoxication can cause people to interact in ways that lead to rejection and feelings of shame. This dynamic can become especially toxic for people with borderline personality disorder. Episodes of heavy drinking may occur in isolation but often become part of a pattern that leads to both psychological and physical dependence on alcohol. Prolonged alcohol dependence is linked with a host of negative health outcomes and an increased risk of suicide for people with borderline personality disorder.

Borderline Personality Disorder and Stimulants

Stimulants can induce temporary states of euphoria and personal power that are appealing to people who feel disempowered or vulnerable. For people with borderline personality disorder, stimulants may help them temporarily overcome feelings of shame or helplessness. Unfortunately, the activation of the sympathetic nervous system by stimulants also causes an immediate increase in anxiety.

Stimulants can also provoke rage and disinhibited aggression, as well as episodes of dysphoria during periods between use. In general, stimulant use intensifies affective instability, which causes significant distress for people with borderline personality disorder and increases their risk of self-destructive or self-harming behavior.

Related Topic: Prevalence of Borderline Personality Disorder & Marijuana

Drug Abuse as a Hindrance to Borderline Personality Disorder Treatment

Helping people recover from borderline personality disorder often involves a multi-stage approach in which skills for emotional self-regulation are established first and are followed by deeper trauma work. This delicate process is easily disrupted by the effects of substance use.

Part of the treatment of borderline personality disorder involves learning to tolerate and self-regulate emotional states, and these skills cannot be established when emotions are being blunted, intensified or disrupted by substance use. Trauma work that involves processing deep emotions is similarly blocked.

Medications used to treat co-occurring mental health disorders or certain symptoms of borderline personality disorder are less effective when they are combined with drug use. Even more significantly, the emotionally disrupting effects of substances slow or block progress in therapy.

Substance abuse often precipitates crises that end with hospitalization or incarceration, especially for people with severe co-occurring mental health conditions like borderline personality disorder. The cycle of managing and recovering from these crises makes it hard for a person to progress in treatment.

Treating Borderline Personality Disorder and Co-Occurring Disorders

The most effective intervention for BPD is dialectical behavior therapy (DBT), which uses cognitive behavioral therapy (CBT) techniques and mindfulness training to help people with borderline personality disorder improve skills and capacities for distress tolerance, impulse control, emotional regulation and interpersonal functioning.

DBT can easily be integrated with established approaches to substance abuse treatment like treatment groups and motivational interviewing (MI), an evidence-based practice that improves treatment retention and recovery outcomes. In DBT, clinicians use group formats and work with clients in a collaborative, nonjudgmental way that is like the approach used in MI. Integrated treatment programs for borderline personality and co-occurring substance use disorders often incorporate both DBT and substance use recovery groups.

A specific version of DBT has been established for the treatment of co-occurring borderline personality and substance use disorders (DBT-SUD). It uses a group format to help people learn standard DBT skills and additional skills targeted at preventing recurrence of substance use. Research by Kienast, Stoffers, Bermpohl and Lieb found that DBT-SUD led to improved recovery outcomes for both disorders. A study by Linehan, Schmidt, and others shows that standard DBT is also an effective treatment for co-occurring borderline personality disorder and substance abuse disorders.

These findings add to a growing body of evidence that recovery is possible for people with BPD and co-occurring disorders. Recent research shows that most people with BPD experience a remission of symptoms, especially with the right treatment. If you or someone you know is struggling with borderline personality disorder and co-occurring addiction, contact The Recovery Village today. A representative can talk to you about how to begin treatment and move into a new phase of recovery.

Editor – Megan Hull

Megan Hull is a content specialist who edits, writes and ideates content to help people find recovery. Read more

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